RESUMO
La fístula quilosa, por daño del conducto torácico, aparece en el 1-2,5% de los pacientes sometidos a disección cervical. Las complicaciones asociadas incluyen desnutrición, compromiso inmune, formación de fístulas y necrosis cutánea con exposición carotídea, e incluso ruptura. De la literatura actual no se puede deducir ningún algoritmo de tratamiento definitivo, pero parece existir un consenso en realizar un manejo conservador de la mayoría de los casos. El manejo médico se basa en la teoría de que si se disminuye el flujo de quilo se permitirá el cierre espontáneo de la fístula, e incluye: drenaje conectado a vacío, reposo, vendaje compresivo (en discusión),intervención nutricional y uso de análogos de somatostatina. El manejo nutricional implica el uso de dietas bajas en grasa suplementadas con Triglicéridos de Cadena Media (MCT), Nutrición Enteral con TCM o Nutrición Parenteral total (NPT) (AU)
Injury to the thoracic duct, leading to chyle leak, occursin 1-2,5% of patients who undergo neck dissection. Associated complications include malnutrition, immunecompromise, fistula formation and carotid blowout. No definitive treatment algorithm can be deduced from the current literature, but on last reviews, there is an agreementon the conservative management. Medical managementis based on that decreasing chyle flow will allow for spontaneous closure of the chyle leak. Conservative treatment includes: closed vacuum drainage, bed-rest,nutrition modification and synthetic somatostatin analog. Nutrition modification involves a low-fat diet supplemented with medium-chain triglycerides (MCT),enteral nutrition with high percentage of MCT or parenteral nutrition (AU)
Assuntos
Humanos , Feminino , Adulto , Fístula/terapia , Ducto Torácico/lesões , Esvaziamento Cervical/efeitos adversos , Quilo , Triglicerídeos/uso terapêutico , Dieta com Restrição de Gorduras , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/efeitos adversosRESUMO
Injury to the thoracic duct, leading to chyle leak, occurs in 1-2,5% of patients who undergo neck dissection. Associated complications include malnutrition, immune compromise, fistula formation and carotid blowout. No definitive treatment algorithm can be deduced from the current literature, but on last reviews, there is an agreement on the conservative management. Medical management is based on that decreasing chyle flow will allow for spontaneous closure of the chyle leak. Conservative treatment includes: closed vacuum drainage, bed-rest, nutrition modification and synthetic somatostatin analog. Nutrition modification involves a low-fat diet supplemented with medium-chain triglycerides (MCT), enteral nutrition with high percentage of MCT or parenteral nutrition.
