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123例乳糜性积液的临床分析

[Clinical analysis of 123 cases of chylous effusion].

作者信息

Xu Kai-feng, Hu Xiao-wen, Tian Xin-lun, Gui Yao-song, Wang Lan, Li Long-yun, Zhu Yuan-jue

机构信息

Department of Respiratory Medicine, Peking Union Medical College Hospital & Chinese Academy of Medical Sciences, Beijing 100730, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2011 Feb 22;91(7):464-8.

Abstract

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 distention (22.8%) and loss of weight (17.1%). Hypoalbuminemia was common (45.5%) and it was even more so in patients with idiopathic lymphopathies or of unknown causes (95.2%). The positive rates of identifying chylous effusion by Sudan III test, high triglyceride levels (> 1.25 mmol/L), lymphangiography or lymphangioscintigraphy 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

Chylous 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.

摘要

目的

分析乳糜性积液的临床特征,提高其诊断和治疗水平。

方法

对我院1990年1月至2009年12月期间收治的123例乳糜性积液患者进行回顾性分析。

结果

乳糜性积液的主要临床表现包括呼吸困难(55.3%)、水肿(26.8%)、腹胀(22.8%)和体重减轻(17.1%)。低蛋白血症较为常见(45.5%),在特发性淋巴管病或病因不明的患者中更为明显(95.2%)。苏丹III试验、高甘油三酯水平(>1.25 mmol/L)、淋巴管造影或淋巴管闪烁造影诊断乳糜性积液的阳性率分别为89.1%、80.6%、70.6%和89.5%。其常见病因包括损伤(14.6%)、恶性肿瘤(9.0%)、感染(7.3%)、淋巴系统疾病或特发性淋巴管病(40%)、药物相关(2.4%)或与基础疾病相关(16.3%)。63.6%的患者治疗有效,21.8%的患者死亡。

结论

乳糜性积液是一种特殊类型的浆液性积液,病因多样。其临床表现往往不具有特异性。但营养不良较为常见。通过系统评估可明确病因。治疗方式包括饮食调整、基础病因管理和手术治疗。

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