Alam Shaan E, Kar Sunny M, Kar Pran M
Department of Nephrology, Veterans Affairs Medical Center, Orlando, Florida, USA.
Saudi J Kidney Dis Transpl. 2016 Mar;27(2):386-90. doi: 10.4103/1319-2442.178573.
Chylous ascites consists of the accumulation of chyle in the peritoneal cavity. Diagnosis is established by cytochemical analysis of the fluid revealing fat globules and high triglyceride content. The majority of cases are caused by pathology that interferes with abdominal retroperitoneal lymphatic drainage. We present two cases of postoperative chylous ascites, one following a bilateral nephrectomy, the other following orthotopic heart transplantation. Treatment is typically conservative with the aim to alleviate abdominal distension and reduce the flow of lymph into the mesenteric lymph nodes. Postsurgical chylous ascites has high cure rate with conservative therapy alone. Therapeutic paracentesis, diuretics, salt restriction, a high-protein, low-fat, mediumchain triglyceride diet, and parenteral nutrition are considered in chronic cases. The effects of longterm paracentesis on patients remains to be seen. In patients requiring renal replacement therapy, removal of chyle during peritoneal dialysis is often attempted.
乳糜性腹水是指乳糜在腹腔内积聚。通过对液体进行细胞化学分析，发现脂肪球和高甘油三酯含量来确诊。大多数病例是由干扰腹部腹膜后淋巴引流的病变引起的。我们报告两例术后乳糜性腹水病例，一例发生在双侧肾切除术后，另一例发生在原位心脏移植术后。治疗通常采用保守治疗，目的是减轻腹胀并减少淋巴液流入肠系膜淋巴结。单纯保守治疗，术后乳糜性腹水的治愈率很高。对于慢性病例，可考虑进行治疗性腹腔穿刺放液、使用利尿剂、限制盐分摄入、采用高蛋白、低脂、中链甘油三酯饮食以及肠外营养。长期腹腔穿刺放液对患者的影响尚有待观察。对于需要肾脏替代治疗的患者，常在腹膜透析过程中尝试清除乳糜。
