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乳糜性浆膜腔积液123例临床分析 被引量:14

Clinical analysis of 123 cases of chylous effusion
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摘要 目的分析乳糜性浆膜腔积液的临床特点,提高该病的诊治水平。方法复习1990-2009年(20年间)北京协和医院乳糜性浆膜腔积液的住院病例资料,分析其临床特点和诊治现状。结果123例乳糜性浆膜腔积液患者常见的的临床表现包括:呼吸困难(55.3%)、水肿(26.8%)、腹胀(22.8%)和消瘦(17.1%)。不管是否有基础疾病,血清白蛋白减低很常见(45.5%)。乳糜试验阳性、浆膜腔积液甘油三酯水平〉1.25mmol/L、淋巴管核素显像以及淋巴管造影的阳性率分别为:89.1%、80.6%、70.6%和89.5%。常见病因包括创伤(14.6%)、恶性肿瘤(9.0%)、感染(7.3%)、淋巴管疾病或特发性淋巴管异常(40%)、药物相关(2.4%)和继发于各种基础疾病(16.3%)等。55例有随访资料:43.6%乳糜积液消失,20%好转,21.8%死亡。结论乳糜性浆膜腔积液病因复杂,临床表现缺乏特异性,但常有明显全身消耗症状。全面系统检查有助于尽早确定病因。常用的治疗方法包括饮食调节、病因治疗和外科治疗。 Objective To analyze the clinical characteristics of chylous effusion and boost its, diagnostic and therapeutic level. Methods A retrospective analysis was conducted for 123 cases of chylous effusion at our hospital between January 1990 and December 2009. Results The main clinical manifestations of chylous effusion included dyspnea ( 55.3% ) , edema ( 26.8% ) , abdominal distentior (22. 8% ) and loss of weight ( 17. 1% ). Hypoalbuminia was common (45.5%) and it was even more so ir patients with idiopathic lymphopathies or of unknown causes (95.2%). The positive rates of identifying chylous effusion by Sudan m test, high triglyceride levels ( 〉 1.25 mmo]/L ), lymphangiography ol lyphangioscintigraphy were 89. 1% , 80. 6% , 70. 6% and 89. 5% respectively. Its common etiologies included injury ( 14. 6% ) , malignancy ( 9.0% ) , infections ( 7.3% ) , lymphatic disorders or idiopathic lymphopathies ( 40% ) , drug-associated ( 2. 4% ) or associated with underlying disorders ( 16. 3% ) . Efficacy was achieved in 63.6% of the patients and 21.8% died. Conclusions Cbylous effusion is a special type of serous effusion with multiple causes. Its clinical manifestations are often nonspecific. But malnutrition is common. Its causes are identified after a systematic evaluation. Treatment modalities include dietary modification, management of underlying causes and surgical approaches.
出处 《中华医学杂志》 CAS CSCD 北大核心 2011年第7期464-468,共5页 National Medical Journal of China
关键词 乳糜性浆膜腔积液 乳糜胸 乳糜腹 乳糜心包积液 Chylous effusion Chylothorax Chylous ascites Chylous pericardial effusion
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