结核性乳糜腹水1例并文献复习  

Chylous ascites due to tuberculosis: a case report and literature review

作　　者：肖科 曹汴川 武正菊 黄富礼 钟利 XIAO Ke;CAO Bianchuan;WU Zhengju;HUANG Fuli;ZHONG Li(Department of Infectious Diseases,the Affiliated Hospital of Southwest Medical University,Luzhou Sichuan 646000,China)

机构地区：[1]西南医科大学附属医院感染科

出　　处：《中国感染与化疗杂志》2019年第4期375-380,共6页Chinese Journal of Infection and Chemotherapy

基　　金：西南医科大学附属医院课题(17174,14037);西南医科大学课题(0903-00030997)

摘　　要：目的了解结核所致乳糜腹水的临床表现、诊断、治疗及预后。方法对1例结核性乳糜腹水患者的临床表现、实验室检查结果、治疗及预后进行分析,并回顾1998-2018年国内外关于此病的文献报道,筛选并总结分析结核性乳糜腹水患者的临床资料。结果该例患者曾有肺结核及腹腔结核病史,抗结核疗程未足自行停药。此次以腹胀、腹围增大为主要表现,腹腔穿刺见大量乳糜腹水,结合患者病史,PET-CT排除恶性病变后再次予以诊断性抗结核治疗,治疗后病情好转,最终考虑结核所致乳糜腹水。结合文献和该院病例,共19例患者,年龄19d^74岁,以腹胀、发热、腹痛为主要表现,11例为临床诊断,8例通过病理学及细菌学确诊;最终诊断为血行播散性结核10例(1例为先天性结核),腹腔结核9例。经治疗后痊愈6例,好转11例,1例死于抗结核药物所致肝衰竭。结论乳糜腹水病因繁多,预后与病因相关,尽早明确原发病是临床治疗的关键,应综合考虑患者营养状况、原发病病情并予以规范化综合治疗;结核所致乳糜腹水患者通过抗结核等综合治疗多数预后良好。Objective To understand the clinical manifestations,diagnosis,treatment and prognosis of chylous ascites due to tuberculosis.Methods The clinical manifestations,laboratory findings,treatment and prognosis were reported in a patient with tuberculous chylous ascites.Relevant literature reports during the period from 1998 to 2018 were reviewed.The clinical data of patients with tuberculous chylous ascites were summarized and discussed.Results The patient had a history of abdominal tuberculosis.He received inadequate anti-tuberculosis treatment and discontinued treatment by himself.The patient developed abdominal distension and enlarged abdominal circumference subsequently.Abdominal puncture showed large amount of chylous ascites.Malignant disease was excluded after positron emission tomography CT scan,and considering the medical history,as well as diagnostic antituberculosis treatment,which improved his condition.Finally tuberculous chylous ascite was considered.Literature review identified 18 similar cases.Together with this case,a total of 19 patients (7 males and 12 females,age from 19 days to 74 years) were analyzed.Abdominal distension,fever,and abdominal pain were the main clinical manifestations.The diagnosis was made clinically in 11 patients,and confirmed in the remaining 8 patients based on pathology and bacteriology.Finally,hematogenous disseminated tuberculosis was confirmed in 10 cases (including 1 case of congenital tuberculosis),and abdominal tuberculosis in 9 cases.As for treatment outcome,6 patients were cured,11 improved,and one patient died of liver failure caused by anti-tuberculosis drugs.Conclusions Chylous ascites may be caused by various causes.The prognosis is related to the specific cause.Identifying the primary disease as early as possible is the key to clinical treatment.Standardized comprehensive treatment should be provided considering the nutritional status of patients and the primary disease.Good outcome is expected in most patients with tuberculous chylous ascites after anti-tubercul

关 键 词：结核 乳糜腹水 治疗 预后 

分 类 号：R526[医药卫生—内科学]