关键词: 肝硬化, 非创伤性乳糜腹水, 临床特征

Abstract: Objective The aim of this study was to summarize the clinical features of patients with cirrhosis-related non-traumatic chylous ascites (CNCA). Methods 12 patients with CNCA were encountered in our Hospital between January 2012 and January 2022, and the medical histories, serum creatinine, liver function tests, ascites, imaging findings, gastroscopic results, therapeutic strategies and prognoses were analyzed retrospectively. Results Out of the 12 patients, 2 patients had experienced esophagogastric variceal bleeding, and 10 patients had ascites before; serum creatinine level was 92.4(79.2,101.7)μmol/L, and Child-Pugh class B was found in 8 cases and Child-Pugh class C in 4 cases; ascitic fluid triglyceride level was(3.9±0.9) mmol/L, and the exudate ascites was found in 9 cases and transudate in 3 cases; the ascites bacteria culture was positive in 2 patients, Escherichia Coli in 1 case and Aeromonas Hydrophila in 1 case, respectively; the ascites cytology showed no malignant; the abdominal CT scan presented with primary liver cancer in 2 cases, portal vein thrombosis in 3 cases, and mild to moderate splenomegaly in 10 cases and megalosplenia in 1 case; the gastroscopy was not performed in 3 persons, and found mild to moderate esophageal varices (EV) in 4 cases and severe EV in 5 cases; the treatment included low-fat diet, combined with conventional therapy such as antibiotics,drainage of ascetic fluid , diuretics in 5 cases, fasting, parenteral nutrition, and somatostatin in 4 cases, fasting, parenteral nutrition, and terlipress in 1 case, and TIPS in 2 cases; the ascites neutrophils count after treatment was (186.9±135.8)/μl, significantly lower than[(377.3±223.5)/μl,P＜0.05] before treatment; the ultrasonography showed the maximum liquid dark area in the abdominal cavities was 2.3(1.4,10.4)cm after therapy, significantly smaller than[(12±2.3)cm,P＜0.05] before therapy; during hospitalizations, there were 9 patients (75.0%) improved, 2 patients (16.7%) didn't respond to therapy, and 1 patients (8.2%)died of liver failure. Conclusion The patients with CNCA should be dealt with appropriately and individually. Under the circumstance of non-responded to conventional therapy, the TIPS might be the alternative.

Key words: Liver cirrhosis, Non-traumatic chylous ascites, Clinical features