Geisler J P, Foster R S, Sutton G P
Department of Obstetrics and Gynecology, Indiana University Medical Center, Indianapolis.
Obstet Gynecol. 1994 May;83(5 Pt 2):883-5.
Chyloperitoneum is an uncommon complication following retroperitoneal surgery. Blunt abdominal trauma, abdominal surgery, abdominal or pelvic radiation, cirrhosis, lymphoma, tuberculosis, and congenital defects of lacteal formation may also lead to chylous ascites.
Two patients developed chylous ascites after treatment for gynecologic malignancies. One, who also received pelvic and abdominal radiation, developed chylous ascites 11 months after retroperitoneal lymph node dissection for advanced endometrial cancer. She was treated with a diet low in fat and high in medium-chain triglycerides, as well as with intravenous hyperalimentation. She had recurrences of chylous ascites, which responded to paracentesis and intravenous hyperalimentation. The second patient developed chylous ascites 2 months after retroperitoneal lymph node dissection for advanced fallopian tube cancer. She was treated with a medium-chain triglyceride diet, which resulted in resolution of her symptoms.
Chyloperitoneum is an uncommon complication following treatment for gynecologic malignancies. Our second case is the first reported in which retroperitoneal lymph node dissection for gynecologic malignancy resulted in chyloperitoneum. However, because gynecologic malignancies frequently metastasize to the periaortic lymph nodes, chylous ascites may be an important cause of morbidity following treatment.
乳糜腹是腹膜后手术罕见的并发症。钝性腹部创伤、腹部手术、腹部或盆腔放疗、肝硬化、淋巴瘤、结核病以及淋巴管形成的先天性缺陷也可能导致乳糜性腹水。
两名妇科恶性肿瘤患者在接受治疗后出现乳糜性腹水。其中一名患者同时接受了盆腔和腹部放疗，在因晚期子宫内膜癌进行腹膜后淋巴结清扫术后11个月出现乳糜性腹水。她接受了低脂、高链甘油三酯饮食以及静脉高营养治疗。她的乳糜性腹水复发，经腹腔穿刺和静脉高营养治疗后缓解。第二名患者在因晚期输卵管癌进行腹膜后淋巴结清扫术后2个月出现乳糜性腹水。她接受了中链甘油三酯饮食治疗，症状得以缓解。
乳糜腹是妇科恶性肿瘤治疗后罕见的并发症。我们的第二个病例是首例报道的因妇科恶性肿瘤进行腹膜后淋巴结清扫导致乳糜腹的病例。然而，由于妇科恶性肿瘤常转移至腹主动脉旁淋巴结，乳糜性腹水可能是治疗后发病的重要原因。
