Shapiro A M, Bain V G, Sigalet D L, Kneteman N M
Department of Surgery, University of Alberta, Edmonton, Canada.
Transplantation. 1996 May 15;61(9):1410-1. doi: 10.1097/00007890-199605150-00023.
Chylous ascites is the accumulation of chylomicronrich lymphatic fluid within the peritoneal cavity. It is a rare complication of retroperitoneal surgery, and may occur spontaneously in 0.5% of patients with cirrhosis. Its management is controversial, and despite a variety of treatment options with limited efficacy, the course is usually indolent. In this article, we report a case of rapid resolution of chylous ascites after liver transplantation following 10 days of treatment using somatostatin analog (Octreotide, 100 micrograms sc. t.i.d.) and total parenteral nutrition (TPN). A 55-year-old man underwent liver transplantation for hepatitis C cirrhosis, and developed an infected chylous fistula on the 10th day. Treatment by fasting, TPN, and somatostatin analog resulted in a rapid falloff in fistula output, with complete resolution of ascites within 2 days. This is the first report, to our knowledge, of somatostatin analog and TPN used in combination for rapid and successful closure of a chylous fistula.
乳糜性腹水是富含乳糜微粒的淋巴液在腹腔内积聚。它是腹膜后手术的一种罕见并发症，在0.5%的肝硬化患者中可能自发出现。其治疗存在争议，尽管有多种治疗选择但疗效有限，病程通常进展缓慢。在本文中，我们报告了一例在使用生长抑素类似物（奥曲肽，皮下注射100微克，每日三次）和全胃肠外营养（TPN）治疗10天后，肝移植后乳糜性腹水迅速消退的病例。一名55岁男性因丙型肝炎肝硬化接受肝移植，术后第10天发生感染性乳糜瘘。通过禁食、TPN和生长抑素类似物治疗，瘘管引流量迅速减少，腹水在2天内完全消退。据我们所知，这是首次报道生长抑素类似物和TPN联合使用可快速成功闭合乳糜瘘。
