肝硬化合并乳糜性腹水34例临床特点分析

Analysis of clinical features of 34 cases with liver cirrhosis complicated with chyious ascites

【摘要】目的总结肝硬化合并乳糜性腹水患者的临床特点。方法回顾2007年7月至2012年11月同时诊断为肝硬化与乳糜性腹水者的病史资料。分析患者病因、肝功能状况、腹水检查、影像学检查、治疗方法及转归。计量资料比较采用U检验。结果共纳入患者34例，其中男27例，女7例，平均年龄为（51．7士12．5）岁。肝硬化病因以乙型肝炎（20／34，58．8％）最为多见，Child—Pugh分级均为B级（26例）和C级（8例）。腹水外观呈乳糜样者17例，血清一腹水白蛋白梯度（SAAG）为18．8（2．6～32．5）g／L，其中SAAG≥11．0g／L者27例（84．4％）。腹水TG为2．94（O．26～16．75）mmol／L，其中〉1．25mmol／L者占27例（84．4％）。SAAG≥11．0g／L者的腹水TG水平[2．66（0．26～16．75）mmol／L]明显低于SAAG〈11．0g／L者[7．07（2．26～15．67）mmol／L，U=24．00，P=0．023。淋巴管核素显像提示造影剂进人腹腔者29例（85．30A），直接淋巴管造影提示淋巴管结构异常者15例（60％）。保守治疗12例，4例有效，行腹腔一静脉腹水转流术13例，12例有效，显微外科手术治疗11例，7例有效。结论淋巴管结构异常可能是肝硬化患者出现乳糜性腹水的重要原因之一；肝硬化合并乳糜性腹水在临床仍表现为门静脉高压性腹水的特点，SAAG水平可能取决于腹水TG含量；淋巴管核素显像用于乳糜性腹水定性诊断价值较大，而直接淋巴管造影有助于发现淋巴管结构异常。

Objective To summarize the clinical characteristics of liver cirrhosis complicated with chylous ascites. Methods From July, 2007 to November, 2012, patients diagnosed as liver cirrhosis complicated with chylous ascites were retrospectively analyzed. Analyze the etiology, liver function, ascites, imaging examination, treatment options and progonsis of these patients. Differences in measurement data were compared with U test. Results A total of 34 cases were enrolled, male 27 cases and female seven cases, average age （51.7~12.5） years old. Hepatitis B （20/34,58.8~） was the most common etiology of liver cirrhosis. Child-Pugh grading was grade B （26 cases） and C （eight cases）. The appearance of ascites of 17 cases was chylous and the serm-ascites albumin gradient （SAAG） was 18. 8 （2.6 to 32.5） g/L. The SAAG of 27 cases （84.4~） was no less than 11.0 g/L. The ascites triglyceride （TG） level was 2.94 （0.26 to 16.75） mmol/L, the TG of 27 cases （84.40/oo） was no less than 1. 25 mmol/L. The level of TG （2. 66（0. 26 to 16.75） mmol/L） of patients with SAAG over 11.0 g/L was significantly lower than that of SAAG lower than 11 g/L （7.07（2.26 to 15.67） mmol/L, U=24.00,P= 0.02）. The lymphatic scintigraphy indicated that imaging agent leaked into peritoneal cavity in 29 cases （85.3 ~）. Direct lymphangiography revealed lymphatic vessel structure abnormality in 15 cases （60~）. Twelve patients received conservative treatment and four patients were effective, 13 patients accepted peritoneal-venous shunting and 12 patients were effective, 11 patients with microsurgical treatment and seven patients were effective. Conclusions Lymphatic struture is a possible cause of cirrhosis patients with chylous ascites. The characteristics of chylous ascites in cirrhosis patients are still the same as the characteristics of portal hypertension ascites. The SAAG remarkably increases, and the the level of SAAG probably depends on TG level. Lymphoseintigraphy has great value on tee determination of the presence of ascites. And the direct lymphangiography could help to reveal lymphatic vessel structure abnormality.