Analysis of clinical features of 34 cases with liver cirrhosis complicated with chylous ascites / 中华消化杂志

ABSTRACT

Objective To summarize the clinical characteristics of liver cirrhosis complicated with chylous ascites.Methods From July,2007 to November,2012,patients diagnosed as liver cirrhosis complicated with chylous ascites were retrospectively analyzed.Analyze the etiology,liver function,ascites,imaging examination,treatment options and progonsis of these patients.Differences in measurement data were compared with U test.Results A total of 34 cases were enrolled,male 27 cases and female seven cases,average age (51.7±12.5) years old.Hepatitis B (20/34,58.8％) was the most common etiology of liver cirrhosis.Child-Pugh grading was grade B (26 cases) and C (eight cases).The appearance of aseites of 17 cases was chylous and the serm-ascites albumin gradient (SAAG) was 18.8 (2.6 to 32.5) g/L.The SAAG of 27 cases (84.4％) was no less than 11.0 g/L.The ascites triglyceride (TG) level was 2.94 (0.26 to 16.75) mmol/L,the TG of 27 cases (84.4％) was no less than 1.25 mmol/L.The level of TG (2.66(0.26 to 16.75) mmol/L) of patients with SAAG over 11.0 g/L was significantly lower than that of SAAG lower than 11 g/L (7.07(2.26 to 15.67) mmol/L,U=24.00,P=0.02).The lymphatic scintigraphy indicated that imaging agent leaked into peritoneal cavity in 29 cases (85.3 ％).Direct lymphangiography revealed lymphatic vessel structure abnormality in 15 cases (60 ％).Twelve patients received conservative treatment and four patients were effective,13 patients accepted peritoneal-venous shunting and 12 patients were effective,11 patients with microsurgical treatrnent and seven patients were effective.Conclusions Lymphatic struture is a possible cause of cirrhosis patients with chylous ascites.The characteristics of chylous ascites in cirrhosis patients are still the same as the characteristics of portal hypertension ascites.The SAAG remarkably increases,and the the level of SAAG probably depends on TG level.Lymphoscintigraphy has great value on the determination of the presence of ascites.And the direct lymphangiography could help to reveal lymphatic vessel structure abnormality.