Corradini Stefanie, Liebig Sylke, Niemoeller Olivier M, Zwicker Felix, Lamadé Wolfram
Department of Radiation Oncology, University of Munich, Marchioninistr. 15, 81377, Munich, Germany,
Strahlenther Onkol. 2015 May;191(5):448-52. doi: 10.1007/s00066-014-0805-z. Epub 2015 Jan 10.
Chylous ascites is a rare complication following pancreaticoduodenectomy. We report on a case of chylous ascites following pancreaticoduodenectomy in a 76-year-old patient diagnosed with pancreatic cancer. There are various known conservative management strategies, including dietary measures or total parenteral nutrition. Unfortunately, conservative treatment-with total parenteral nutrition and fasting over a period of 4 weeks-was not successful in the present case. The daily output volume of chylous ascites was up to 2500 ml/day. Based on clinical experiences with successfully treated lymphocutaneous fistulas, low-dose radiotherapy was initiated. External beam radiotherapy comprising a total dose of 8.0 Gy to the paraaortic lymph node region was administered in daily single fractions of 1.0 Gy (five fractions/week). Throughout the course of external beam radiotherapy, the secretion of abdominal ascites rapidly decreased, resulting in complete resolution after 2 weeks. There was no clinical evidence of chylous ascites on follow-up. As a result of this experience, we believe that external beam radiotherapy should be considered as an alternative therapy in refractory cases of chylous ascites.
乳糜性腹水是胰十二指肠切除术后一种罕见的并发症。我们报告了一例76岁诊断为胰腺癌的患者在胰十二指肠切除术后发生乳糜性腹水的病例。目前有多种已知的保守治疗策略，包括饮食措施或全胃肠外营养。不幸的是，在本病例中，采用全胃肠外营养和禁食4周的保守治疗并未成功。乳糜性腹水的每日引流量高达2500毫升/天。基于成功治疗淋巴皮肤瘘的临床经验，开始进行低剂量放疗。对腹主动脉旁淋巴结区域进行了总量为8.0 Gy的外照射放疗，每日单次剂量为1.0 Gy（每周5次）。在整个外照射放疗过程中，腹腔积液的分泌迅速减少，2周后完全消退。随访时没有乳糜性腹水的临床证据。基于这一经验，我们认为外照射放疗应被视为难治性乳糜性腹水病例的一种替代治疗方法。
