摘要
目的总结肝硬化合并乳糜性腹水的临床特点。方法回顾性分析我院消化内科2008年1月至2012年11月诊断为肝硬化并乳糜性腹水患者的临床资料，结合国内外文献进行分析。结果3例患者符合标准．均为男性，年龄50～57岁，肝硬化诊断时间1个月～2年，Child—pugh分级均为B—C级，腹水甘油三酯含量1．28．2．66mmol／L，血清-腹水白蛋白梯度（serum ascite salbumi ngradient。SAAG）22．7～27．7g／L。淋巴管核素显像均见显影剂漏出。1例患者给予奥曲肽皮下注射治疗后腹水控制。1例患者直接淋巴管造影提示胸导管出口功能性梗阻，行胸导管-左颈静脉吻合术后控制不佳，后行腹腔-静脉腹水转流术．随访2年控制良好。1例患者既往为清亮腹水，本次转为乳糜性腹水．行腹腔-静脉腹水转流术后腹水-度控制，但很快再次恶化，患者死亡。结论肝硬化合并的乳糜性腹水仍表现为漏出液及门脉高压性腹水特点。淋巴管核素显像可能有助于乳糜性腹水的定性诊断。皮下注射奥曲肽与腹腔-静脉腹水转流术可能均可有效控制肝硬化合并的乳糜性腹水。
Objective To summarize the clinical characteristics of chylous ascites in cirrhosis. Methods Analyze retrospectively the clinical records of patients diagnosed as cirrhosis with chylous ascites in gastroenterology department of our hospital between January, 2008 and November, 2012, as well as related literatures. Results There were 3 male pa tients aging 50-57 years old meeting the criteria, of which cirrhosis was diagnosed 1 month to 2 years earlier. Liver func tion graded as Child-Pugh B to C. Ascitic triglyceride level was 1.28-2.66mmol/L. The ratio of TG level in ascites to serum were 0.95-3.55. And the SAAG was 22.7-27.7g/L. The radioactive tracer were all detected leaking to peritoneal cavity during lymphoscintigraphy. Ocreotide was given to one patient subcutaeously and ascites was controlled. Another pa tient underwent direct lymphangiography revealing thoracic duct outlet functional obstruction and subsequent left jugular vein anastomosis failing to control the ascites. Then peritoneal-venous shunting was established and the patient kept well in following 2 years. The last patient underwent a transformation of ascitic appearance from clear to chylous. Although the Denver shunt alleviated his ascetic fluid initially, his condition quickly aggravated to death. Conclusion As common ascites in cirrhosis, the property of chylous ascites is consistent with transudates and SAAG elevates remark ably. Lymphoscintigraphy may help to determine the leakage of lymphatic fluid. Subcutaneously oereotide and Denver shunt may be efficient for controlling chylous ascites in cirrhosis.
出处
《北京医学》
CAS
2013年第9期784-786,共3页
Beijing Medical Journal
关键词
肝硬化
乳糜性腹水
文献复习
Cirrhosis Chylous ascites Literature review
