中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2011年
7期
464-468
,共5页
徐凯峰%胡晓文%田欣伦%桂耀松%王岚%李龙芸%朱元珏
徐凱峰%鬍曉文%田訢倫%桂耀鬆%王嵐%李龍蕓%硃元玨
서개봉%호효문%전흔륜%계요송%왕람%리룡예%주원각
乳糜性浆膜腔积液%乳糜胸%乳糜腹%乳糜心包积液
乳糜性漿膜腔積液%乳糜胸%乳糜腹%乳糜心包積液
유미성장막강적액%유미흉%유미복%유미심포적액
Chylous effusion%Chyiothorax%Chylous ascites%Chylous pericardial effusion
目的 分析乳糜性浆膜腔积液的临床特点,提高该病的诊治水平.方法 复习1990-2009年(20年间)北京协和医院乳糜性浆膜腔积液的住院病例资料,分析其临床特点和诊治现状.结果 123例乳糜性浆膜腔积液患者常见的的临床表现包括:呼吸困难(55.3%)、水肿(26.8%)、腹胀(22.8%)和消瘦(17.1%).不管是否有基础疾病,血清白蛋白减低很常见(45.5%).乳糜试验阳性、浆膜腔积液甘油三酯水平＞1.25 mmol/L、淋巴管核素显像以及淋巴管造影的阳性率分别为:89.1%、80.6%、70.6%和89.5%.常见病因包括创伤(14.6%)、恶性肿瘤(9.0%)、感染(7.3%)、淋巴管疾病或特发性淋巴管异常(40%)、药物相关(2.4%)和继发于各种基础疾病(16.3%)等.55例有随访资料:43.6%乳糜积液消失,20%好转,21.8%死亡.结论 乳糜性浆膜腔积液病因复杂,临床表现缺乏特异性,但常有明显全身消耗症状.全面系统检查有助于尽早确定病因.常用的治疗方法包括饮食调节、病因治疗和外科治疗.
目的 分析乳糜性漿膜腔積液的臨床特點,提高該病的診治水平.方法 複習1990-2009年(20年間)北京協和醫院乳糜性漿膜腔積液的住院病例資料,分析其臨床特點和診治現狀.結果 123例乳糜性漿膜腔積液患者常見的的臨床錶現包括:呼吸睏難(55.3%)、水腫(26.8%)、腹脹(22.8%)和消瘦(17.1%).不管是否有基礎疾病,血清白蛋白減低很常見(45.5%).乳糜試驗暘性、漿膜腔積液甘油三酯水平＞1.25 mmol/L、淋巴管覈素顯像以及淋巴管造影的暘性率分彆為:89.1%、80.6%、70.6%和89.5%.常見病因包括創傷(14.6%)、噁性腫瘤(9.0%)、感染(7.3%)、淋巴管疾病或特髮性淋巴管異常(40%)、藥物相關(2.4%)和繼髮于各種基礎疾病(16.3%)等.55例有隨訪資料:43.6%乳糜積液消失,20%好轉,21.8%死亡.結論 乳糜性漿膜腔積液病因複雜,臨床錶現缺乏特異性,但常有明顯全身消耗癥狀.全麵繫統檢查有助于儘早確定病因.常用的治療方法包括飲食調節、病因治療和外科治療.
목적 분석유미성장막강적액적림상특점,제고해병적진치수평.방법 복습1990-2009년(20년간)북경협화의원유미성장막강적액적주원병례자료,분석기림상특점화진치현상.결과 123례유미성장막강적액환자상견적적림상표현포괄:호흡곤난(55.3%)、수종(26.8%)、복창(22.8%)화소수(17.1%).불관시부유기출질병,혈청백단백감저흔상견(45.5%).유미시험양성、장막강적액감유삼지수평＞1.25 mmol/L、림파관핵소현상이급림파관조영적양성솔분별위:89.1%、80.6%、70.6%화89.5%.상견병인포괄창상(14.6%)、악성종류(9.0%)、감염(7.3%)、림파관질병혹특발성림파관이상(40%)、약물상관(2.4%)화계발우각충기출질병(16.3%)등.55례유수방자료:43.6%유미적액소실,20%호전,21.8%사망.결론 유미성장막강적액병인복잡,림상표현결핍특이성,단상유명현전신소모증상.전면계통검사유조우진조학정병인.상용적치료방법포괄음식조절、병인치료화외과치료.
Objective To analyze the clinical characteristics of chylous effusion and boost its diagnostic and therapeutic level. Methods A retrospective analysis was conducted for 123 cases of chylous effusion at our hospital between January 1990 and December 2009. Results The main clinical manifestations of chylous effusion included dyspnea ( 55.3% ), edema ( 26. 8% ), abdominal distention (22. 8% ) and loss of weight ( 17. 1% ). Hypoalbuminia was common (45. 5% ) and it was even more so in patients with idiopathic lymphopathies or of unknown causes (95.2%). The positive rates of identifying chylous effusion by Sudan Ⅲ test, high triglyceride levels ( ＞ 1.25 mmol/L), lymphangiography or lyphangioscintigraphy were 89. 1%, 80. 6%, 70. 6% and 89. 5% respectively. Its common etiologies included injury ( 14. 6% ), malignancy (9. 0% ), infections ( 7.3% ), lymphatic disorders or idiopathic lymphopathies ( 40% ), drug-associated ( 2. 4% ) or associated with underlying disorders ( 16. 3% ).Efficacy was achieved in 63.6% of the patients and 21.8% died. Conclusions Chylous effusion is a special type of serous effusion with multiple causes. Its clinical manifestations are often nonspecific. But malnutrition is common. Its causes are identified after a systematic evaluation. Treatment modalities include dietary modification, management of underlying causes and surgical approaches.
