Related Factors And Management Of Chylous Fistulaafter Neck Lymph Node Dissection

Objective:To explore the related factors of chylous fistula after neck lymph node dissection(ND),And to evaluate the incidence and management of chylous fistula after cervical dissection in our hospital.Methods:Retrospective analysis of 439 cases of ND from January 2013 to November 2018,According to the presence or absence of chylous fistula,the patients were divided into Chylous fistula group and non-chylous fistula group,Multivariate analysis was made on 36 related factors,including general condition,tumor stage,IV lymph node,N stage,operative neck dissection,intraoperative lymphatic vessel exposure,positive or negative cervical lymph node metastasis after operation,Bivariate regression analysis was used to determine the related factors of chylous fistula after ND,To evaluate the incidence of chylous fistula in our hospital,the occurrence of complications in two groups,and to summarize our experience in the treatment of cervical chylous fistula..Results:In 439 cases,Postoperative chylous fistula occurred in 28 cases(6.38%),Univariate analysis:Diabetes mellitus,lymphatic metastasis stage(N stage),history of cervical surgery,preoperative imaging findings of IV lymph node enlargement,intraoperative neck dissection,neck dissection side,IV areadissection,neck lymph node metastasis,especially neck IV area lymph node metastasis,were risk factors for chylous fistula after ND(P<0.05).Logistic regression analysis showed that sex,neck operation history,intraoperative lymphatic exposure and drinking history were independent risk factors for chylous fistula(P<0.05).In chylous fistula group,serum albumin and electrolyte decreased to some extent before and after operation,and the percentage of albumin,blood potassium and lymphocyte had statistical significance after operation(P<0.05).Postoperative complications such as hypoproteinemia,hypokalemia and hypolymphocythemia were significantly different(P < 0.05).Conclusions:The incidence of chylous fistula after ND(6.4%)is basically consistent with the domestic and foreign studies.Diabetes mellitus,alcohol consumption,history of cervical surgery,cervical lymph node metastasis,radical neck dissection,intraoperative lymph node dissection in area IV and lymphatic vessel exposure and ligation are risk factors for chylous fistula after cervical dissection.The occurrence of chylous fistula is liable to lead to electrolyte disorder,hypoproteinemia,hypolymphocythemia,decreased immune function,skin flap floating,etc.High calorie,high protein and low fat diet should be given to monitor electrolyte and correct electrolyte disorder in time.Conservative treatment and surgical treatment indications should be mastered in treatment.Careful operation during operation to reduce lymphatic vessel exposure and treatment can reduce neck clearance.The occurrence and complications of chylous fistula after operation.