Báo cáo ca bệnh tràn dịch dưỡng chấp ổ bụng/u lympho không Hodgkin tế bào B thể nang=Reporting a case study: Chylous ascites/follicular lymphoma

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Tác giả: Lan Phương Nguyễn, Thị Thảo Nguyễn, Đức Bình Vũ

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2024

Mô tả vật lý: tr.260-266

Bộ sưu tập: Metadata

ID: 478250

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Serous effusions are a common complication of lymphomas. Although the frequency of pleural effusion is 20–30% in non-Hodgkin's lymphoma and Hodgkin's disease, the involvement of peritoneal and pericardial cavities is uncommon. Chylous ascites is a rare form of ascites resulting from an accumulation of lymph in the abdominal cavity. It was characterized by a milky appearance, negative cytology, and an elevated ascitic fluid triglyceride concentration. The most common causes in Western countries are abdominal malignancy (especially in adults, in whom lymphoma accounted for at least one third of the cases in one large series of patients identified over 20 years) and cirrhosis (which accounts for over two thirds of all cases). Chylous ascites frequently presents as progressive and painless abdominal distention. Patients may complain of weight gain, shortness of breath, and dyspnea resulting from increased abdominal pressure. A diagnostic paracentesis, which is the most important diagnostic tool. Chylous ascites might occur due to different mechanisms: (a) obstruction of the lymph flow caused by external pressure (mass) causing leakage from dilated subserosal lymphatics into the peritoneal cavity
(b) exudation of lymph through the walls of dilated retroperitoneal vessels lacking valves, which leak fluid through a fistula into the peritoneal cavity as in congenital lymphangiectasia. We reported a case study: Chylous ascites/follicular lymphoma was successfully treated with Rituximab – Bendamustine in National Institute Hematology and Blood Transfusion.Tràn dịch là một biến chứng phổ biến trong u lympho. Mặc dù tần suất tràn dịch màng phổi là 20–30% trong u lympho không Hodgkin và Hodgkin, nhưng tràn dịch dưỡng chấp ổ bụng và màng ngoài tim là không phổ biến. Tràn dịch dưỡng chấp ổ bụng là một dạng tràn dịch hiếm gặp do sự tích tụ bạch huyết trong khoang màng bụng. Nó được đặc trưng bởi dịch màu trắng đục, tế bào học âm tính và nồng độ chất béo trung tính trong dịch dưỡng chấp tăng cao. Nguyên nhân phổ biến nhất ở các nước phương Tây là bệnh ác tính ở vùng bụng (đặc biệt ở người lớn, trong đó u lympho chiếm ít nhất một phần ba số trường hợp trong một loạt bệnh nhân được xác định trên 20 năm) và xơ gan (chiếm hơn hai phần ba tổng số trường hợp). Tràn dịch dưỡng chấp ổ bụng thường biểu hiện chướng bụng tăng dần và không đau. Bệnh nhân có thể phàn nàn về việc tăng cân, khó thở do tăng áp lực ổ bụng. Chọc dò dịch để chẩn đoán là quan trọng nhất. Nó có thể xảy ra do các cơ chế khác nhau: (a) tắc nghẽn dòng bạch huyết do áp lực bên ngoài gây rò rỉ từ các mạch bạch huyết dưới thanh mạc giãn nở vào khoang phúc mạc
(b) bạch huyết tiết ra qua thành của các mạch máu sau phúc mạc bị giãn thiếu van, chất lỏng rò rỉ qua lỗ rò vào khoang phúc mạc như trong giãn mạch bạch huyết bẩm sinh. Chúng tôi xin báo cáo ca bệnh: Tràn dịch dưỡng chấp ổ bụng/u lympho không Hodgkin tế bào B thể nang được điều trị với phác đồ rituximab – bendamustine tại Viện Huyết học - Truyền máu Trung ương.

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