Hepatic Hydrothorax: Clinical Experience and Analysis
摘要
Hepatic hydrothorax has been recognized as a pleural effusion complicated with cirrhosis of the liver. The reported incidence in literature is 4-6%. However, the etiology and management of this disorder is disputed and problematic. From January 1990 through July 1994, we found 72 cases of hepatic hydrothorax coming from 2,490 hospitalized patients of liver cirrhosis. The incidence is 3% in this study. We selected 42 patients (25 males and 17 females) of symptomatic hepatic hydrothorax for clinical analysis and investigation. The patient's age ranged from a 25 year-old to an 82 year-old with a mean age of 57.0 years. The etiology of liver cirrhosis was hepatitis B (24 patients), hepatitis C (9 patients), alcoholic (7 patients), biliary (1 patient), and Wilson's disease (1 patient). Most of the cases were classified as Child's B and C status. Location of hydrothorax showed 33 in right, 9 in bilateral, and none in left alone. Initial aspirates from the peritoneocentesis proved transudative except one with bloody nature. Hypoalbuminemia (＜3.5 gm/dl) is a very common feature (88%, 37/42). Clinical analysis showed splenomegaly in 26 cases, cytopenia in 8 cases, and spontaneous bacterial peritonitis (SBP) in 11 cases. Panendoscopy was performed in 26 out of the 42 patients. Eighty-five percent (85%) demonstrated esophagogastric varices (EV, 20 cases; EV+GV, 2 cases). All of the patients received salt restriction, diuretics, and album in replacement. Paracentesis, thoracostomy with chemical pleurodesis, continuous positive airway pressure (CPAP), and peritoneovenous shunt were performed according to individual consideration. The main purpose of the treatment of this disorder is the intervention to eliminate the ascites and pleural effusion, as well as to avoid complications. Only 6 out of 30 follow-up cases survived for 4 years. The major causes of death were hepatic failure, gastrointestinal bleeding, and sepsis.