| Of all cases of cirrhosis-related ascites, only 0.5%-1% is chylous[112]. The underlying mechanism is believed to be excessive hepatic and gastrointestinal lymph flow and pressure secondary to PH, which may lead to spontaneous rupture of serosal lymphatic channels[113]. 其潜在机制被认为是继发于PH的肝和胃肠道淋巴流量过多和压力，这可能导致浆膜淋巴通道[113]的自发性破裂。 Triglyceride level > 110 mg/dL or the presence of chylomicrons in pleural or ascitic fluid is used to confirm the diagnosis[113-116]. 使用甘油三酯水平＞110mg/dL或胸膜或腹水液中存在乳糜微粒来确认诊断[113-116]。 High protein, low-fat diet (supplemented with medium-chain triglycerides) with sodium restriction and diuretics form the first-line of management[113]. 高蛋白、低脂饮食（添加中链甘油三酯），限制性钠和利尿剂是[113]的一线管理方案。 Octreotide, a somatostatin analog, has been used successfully in some patients but requires long-term therapy to achieve and maintain consistent symptom control[117]. 奥曲肽是一种生长抑素类似物，已成功应用于一些患者，但需要长期治疗来实现和维持一致的症状控制[117]。 Given the rarity of the disease, the evidence on the role of TIPS in this condition is limited to seven case reports and one series of 4 patients[118-126]. 鉴于这种疾病的罕见性，关于TIPS在这种情况下的作用的证据仅限于7例病例报告和1个系列的4例患者[118-126]。 Four patients received covered stents, while five patients received bare stents. In two patients, the stent type was not described[118,123]. 4例患者接受覆膜支架，5例患者接受裸支架。在2例患者中，支架类型未被描述为[118,123]。 TIPS was uniformly successful in providing symptomatic relief in all these cases without any major procedure-related complications, except self-limiting HE in three patients. 在3例患者中，除自限性HE外，TIPS均一致成功地提供了症状缓解，没有任何主要的手术相关并发症。 On mean patient follow-up of 13.9 mo (range 0.6-35), one patient had TIPS dysfunction with recurrence of chylous ascites twice (at 43 d and 70 d post procedure), but the ascites improved after TIPS revision on both occasions. Based on available published literature and the fact that prospective controlled trials with adequate sample size are likely to remain unavailable shortly, TIPS can be considered an effective and safe method for treating chylothorax and chylous ascites in patients with cirrhosis. 在患者平均随访13.9个月（范围0.6-35）时，1例患者出现TIPS功能障碍，乳糜腹水复发两次（术后43天和70天），但两次TIPS翻修后腹水均有所改善。基于现有已发表的文献以及具有足够样本量的前瞻性对照试验可能很快无法获得的事实，TIPS可以被认为是治疗肝硬化患者乳糜胸和乳糜腹水的一种有效和安全的方法。 |