Chen Jaime, Lin Robert K, Hassanein Tarek
Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of California, San Diego, CA 92161, USA.
J Clin Gastroenterol. 2005 Oct;39(9):831-3. doi: 10.1097/01.mcg.0000177232.51888.2e.
Chylous ascites is uncommon and occurs in about 1 in 20,000 hospital admissions. Causes include disruption of the lymphatic system due to malignancy, cirrhosis, surgery, or radiation therapy. The mainstay of therapy has been low-fat diet supplemented with medium-chain triglyceride oil. However, dietary compliance can be difficult to achieve for adequate response. We report a 47-year-old man with hepatitis C and alcohol-related cirrhosis with new-onset chylous ascites and chylothorax. His ascites triglyceride was 585 mg/dL, and the pleural fluid triglyceride was 691 mg/dL. Ascitic and pleural fluid cytology and acid-fast bacilli stain were negative. The patient was treated with low-fat diet and medium-chain triglyceride oil. However, his ascites remained chylous after 1 week of treatment because of poor compliance with the dietary restrictions. Orlistat was then added to his treatment regimen. A half week later, the chylous component of his ascites resolved. Remaining high-volume clear ascites was treated with placement of a transjugular intrahepatic portosystemic shunt. To our knowledge, orlistat has never been used in the treatment of chylous ascites. This case suggests the potential value of adding orlistat to low-fat diet and medium-chain triglyceride oil in the treatment of chylous ascites, especially in patients who are unable to comply with the dietary restrictions.
乳糜性腹水并不常见，在每20000例住院患者中约有1例发生。病因包括恶性肿瘤、肝硬化、手术或放射治疗导致的淋巴系统破坏。治疗的主要方法一直是低脂饮食并补充中链甘油三酯油。然而，要达到足够的治疗反应，饮食依从性可能很难实现。我们报告一名47岁患有丙型肝炎和酒精性肝硬化的男性，新发乳糜性腹水和乳糜胸。他的腹水甘油三酯为585mg/dL，胸水甘油三酯为691mg/dL。腹水和胸水的细胞学检查及抗酸杆菌染色均为阴性。患者接受低脂饮食和中链甘油三酯油治疗。然而，由于对饮食限制的依从性差，治疗1周后他的腹水仍为乳糜性。随后在他的治疗方案中加入了奥利司他。半周后，他腹水中的乳糜成分消退。剩余的大量清亮腹水通过经颈静脉肝内门体分流术进行治疗。据我们所知，奥利司他从未用于治疗乳糜性腹水。该病例表明，在低脂饮食和中链甘油三酯油治疗乳糜性腹水时，尤其是在无法遵守饮食限制的患者中，加入奥利司他可能具有潜在价值。
