Barakat Hashem M, Shahin Yousef, McCollum Peter
Academic Vascular Surgical Unit, Hull York Medical School, University of Hull, Hull, United Kingdom.
Vasc Endovascular Surg. 2012 Nov;46(8):682-5. doi: 10.1177/1538574412457083. Epub 2012 Aug 17.
Chylous ascitis is a rare complication of abdominal aortic aneurysm (AAA) surgery with only 38 cases reported since the early 70s. Due to their anatomical relation with the abdominal aorta, cisterna chyli injury is more common following open AAA repairs when compared to other surgeries; 81% of all postsurgical chylous ascites reported.
We present a case of severe chylous ascitis following elective AAA repair in a 76-year-old caucasian male who gradually developed abdominal distension following discharge. A conservative approach was followed by a peritoneovenous shunt insertion, but this had no clinical benefit. The site of chyle leak was identified and ligated at relaparatomy to eventually resolve his ascitis.
Many reports in literature demonstrate successful conservative measures and highlight the importance of nutritional status in the course of persistent postoperative chylous ascitis. In our experience, complete resolution only came after relaparatomy and repair of leaking lymphatics.
乳糜性腹水是腹主动脉瘤（AAA）手术的一种罕见并发症，自70年代初以来仅报告了38例。由于乳糜池与腹主动脉的解剖关系，与其他手术相比，开放性AAA修复术后乳糜池损伤更为常见；在所有报告的术后乳糜性腹水中占81%。
我们报告一例76岁白种男性择期AAA修复术后发生严重乳糜性腹水的病例，该患者出院后逐渐出现腹胀。先采取保守治疗，后插入腹腔静脉分流管，但未取得临床效果。在再次剖腹手术中确定了乳糜漏的部位并进行结扎，最终解决了他的腹水问题。
文献中的许多报告都证明了保守措施的成功，并强调了营养状况在持续性术后乳糜性腹水中的重要性。根据我们的经验，只有在再次剖腹手术并修复渗漏淋巴管后才能完全治愈。
