A Clinic Analysis Of The Chylous Leakage After Axillary Lymph Node Dissection By 6 Cases

Background:Injury to the thoracic duct/lymphatic vessel leading to chylous leakage is a known complication following several surgical procedures,typically abdominal,neck,or thoracic operations.Any inappropriate treatment may cause severe consequence.Such as local skin flap necrosis,electrolyte disturbance and etc.Because dissection levels in the axilla are anatomically remote from the thoracic duct,Chylous Leakage after axillary lymph node dissection is exceedingly rare;However, major anatomical variations in the termination of the thoracic duct may occur,rendering it susceptible to injury.Our research in order to move forward a single step in the diagnosis and treatment of the chylous leakage and hope to do some help to lower the possibility of the operative complication and boost the operating effect as well as safety.Objective:We encountered six chylous leakage cases after axillary lymph node dissection out of a total of 882 breast cancer cases between July 2005 and June 2007 in Shandong Provincial hospital and in order to explore the diagnosis,therapy and prevention of the chylous leakage after axillary lymph node dissection in breast cancer.Material and method:1.Material All six patients were female ranged in age from 38 to 65 years(average:46),and were admitted to the department with breast tumors.All six patients were female ranged in age from 38 to 65 years (average:46),and were admitted to the department with breast tumors. Detailed information of the six women including clinical manifestation, operative method and postoperative pathology was shown in table 1. Paraffin embedding pathology showed that all the six cases were invasive ductal breast carcinomas.2.Method:All patients underwent modified radical mastectomy with complete axillary clearance(Levelâ… ,â…¡andâ…¢nodes).The operative procedure was uneventful.Result:On the commencement of a normal diet the morning after surgery, all the patients started draining milky fluid.Fluid analysis showing to be chyle confirmed the diagnosis.All six patients received conservative treatments,which included the following:1,modified the diet structures: A high calorie,high protein,low fat and low sodium diet was given.A medium chain triglyeride diet was recommended[1];2,drained adequately via the axillary drain.The six patients were all drained with negative pressure,which had good effects;3,bandaged to the operation area with appropriate pressure.Conclusion:Chylous leakage after axillary lymph node dissection is a rare complication.It can always cured by conservative treatment.Lymph ducts should be emphasized when dissectingâ…¡,â…¢level lymphnode.More ligatures are recommended.