【摘要】 目的　探讨乳糜腹的诊断与治疗。方法　用乳糜液常规检查、乳糜液定量分析、直接淋巴管造影、直接淋巴管造影后CT、核素淋巴显像、MRI诊断乳糜腹患者共 4 0例 ,其中保守治疗组 2 2例。“截流”手术、显微淋巴回流重建手术治疗组 18例。结果　乳糜腹的病理生理改变和淋巴管系结构缺陷是普遍存在的问题 ,全胃肠外营养支持治疗均有效。随访 1个月至 5 5年 ,单纯保守治疗组 :临床良好控制患者 9例 ,好转 6例 ,疗效差 7例。手术治疗组 :临床良好控制患者 11例 ,好转 4例 ,疗效差 3例。全组共死亡 7例患者。结论　直接淋巴管造影和直接淋巴管造影后的CT影像是重要的诊断手段。在选择治疗方式时 ,应全面考虑目前患者疾病的情况与将来可能的淋巴系结构缺陷。胸导管左颈外静脉显微吻合术、腹腔内和腹膜后淋巴管 (干 )生殖静脉显微吻合术等改善淋巴、乳糜回流状态的术式值得探索。淋巴显微外科将在淋巴乳糜回流障碍疾病治疗中起积极的作用。更多还原

【Abstract】 Objective To discuss the diagnosis and therapy of chylous ascites. Methods To diagnose 40 patients of chylous ascite with regular test and quantitative analysis of chyle, direct lymphangiography, CT (immediately after direct lymphangiography), lymphangioscintigraphy, MRI. Twenty two patients received conservative therapy, 18 patients received retroperitoneal lymphangiectomy and (or) lymph vein shunting. Results Lymphatic dysplasia and chylous reflux were found in almost every patient, total parenteral nutrition showed good results. Followed up from 1 month to 5 years, in conservative therapy group, 9 patients were controlled well clinically, the condition of 6 patients was improved better. Seven patients showed no effect. In operation group, 11 patients were controlled well clinically. Four patients got mitigated.Total 7 patients died,although 4 of them ameliorated temporarily. Conclusions Direct lymphangiography, CT (immediately after direct lymphangiography) are the most important diagnosis methods. The influence of the therapy to the malformed lymphatic system of patients should be well considered. Lymph vein shunting, such as thoracic duct left external jugular vein anastomosis, gastroenteral or retroperitoneal lymphatics testicular or ovarian vein anastomosis, could improve the circulation of lymph and chyle of patients. Lymphatic microsurgery will play more and more important roles in the treatment of chylous diseases.更多还原