目的 总结颈部淋巴结清扫术导致乳糜漏的治疗方法。方法 回顾性分析2021年7月至2023年5月空军军医大学唐都医院耳鼻咽喉头颈外科诊治的6例乳糜漏患者的临床资料。其中,右侧中央区淋巴结清扫术后乳糜漏1例,双侧颈部淋巴结清扫术后左侧乳糜漏5例。这6例患者中,术中发生、术后再发乳糜漏1例,术中发生乳糜漏1例,术后乳糜漏4例。综合分析术中及术后不同时机乳糜漏的处理方法。结果 所有乳糜漏患者经相应措施处理后均治愈。6例患者中,1例术中乳糜漏予以左侧颈静脉角局部结扎+肩胛舌骨肌瓣缝合封堵,术后第2天患者再次乳糜漏,经禁食、静脉营养、卧床休息、持续引流、加压包扎及50%高渗葡萄糖溶液注射等保守治疗后患者治愈；另1例患者术中发生大量乳糜漏,行左侧颈静脉角局部结扎+肩胛舌骨肌瓣肌浆生物胶粘贴封堵,术后患者未出现乳糜漏；另其他4例患者术中未发现乳糜漏,但术后出现,3例患者经上述保守方法治疗后治愈,剩余1例患者保守治疗无效,行胸腔镜探查+胸导管结扎术,术后患者治愈。结论 乳糜漏是颈部淋巴结清扫术导致的较严重并发症,若术中一旦出现,可行左侧颈静脉角局部结扎+肩胛舌骨肌瓣肌浆粘贴封堵；若术后出现,大部分患者经积极保守治疗后可治愈；若保守治疗效果欠佳,可行胸腔镜探查行胸导管结扎术。
Objective To summarize the treatment of chylorrhea caused by cervical lymph node dissection. Methods The clinical data of 6 cases of chylorrhea diagnosed and treated by the Department of Otolaryngology, Head and Neck Surgery, Tangdu Hospital, Air Force Military Medical University from July 2021 to May 2023 were retrospectively analyzed. There were 1 case of chylorrhea after right central lymph node dissection and 5 cases of chylorrhea after bilateral neck lymph node dissection. Among the 6 patients, there was 1 intraoperative and postoperative chylorrhea, 1 intraoperative chylorrhea, and 4 postoperative chylorrhea. The treatment of chylous leakage during and after operation was analyzed comprehensively. Results All patients with chylorrhea were cured after corresponding treatment. Among the 6 patients, 1 case of chylorrhagia was treated with local ligation of the left jugular vein corner plus closure of the omohyoid muscle flap. The patient was cured again on the 2nd day after surgery after conservative treatment including fasting, intravenous nutrition, bed rest, continuous drainage, pressure bandaging and 50% hypertonic glucose solution injection. The other patient had a large amount of chylorrhea during the operation, and underwent local ligation of the left jugular vein corner and myoplasmic bioadhesive closure of the omohyoid muscle flap, but no chylorrhea occurred after the operation. In the other 4 patients, chylorrhea was not found during the operation, but appeared after the operation. 3 patients were cured after the conservative treatment described above, and the remaining 1 patient was cured after the conservative treatment failed, and thoracoscopic exploration plus thoracic catheter ligation was performed. Conclusion Chylorrhea is a serious complication caused by cervical lymph node dissection. If it occurs during the operation, local ligation of the left jugular vein corner and myoplasmic closure of the omohyoid muscle flap are feasible. If it occurs after surgery, most patients can be cured after active conservative treatment; If the conservative treatment is not effective, thoracoscopic exploration can be performed with thoracic catheter ligation.