Hepatic hydrothorax.
Hepatic hydrothorax.
复制标题
肝性胸水。
DOI：
10.1097/00132980-200310000-00004
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发表时间：
2003
影响因子：
3.3
通讯作者：
J. Keddissi
中科院分区：
文献类型：
--
作者：
G. Kinasewitz;J. Keddissi
肝性胸水是肝硬化门脉高压症患者在没有心肺疾病的情况下发生的胸腔积液。胸腔积液来源于腹水，腹水由于胸膜腔内的负压经由隔膜中的缺陷而进入胸腔。即使腹水在临床上并不明显，也可以通过核扫描显示腹膜至胸膜的液体流动。胸膜液通常具有漏出液的特征。然而，偶尔有肝性胸水患者会发生自发性细菌性胸膜炎，表现为胸膜液中性粒细胞增多或细菌培养阳性，需要抗生素治疗。胸腔积液的治疗针对潜在的肝脏疾病，但呼吸困难的患者可以通过胸腔穿刺术或穿刺术得到缓解。当药物治疗失败时，肝移植是首选的治疗方法。经颈静脉肝内门体分流术和胸腔镜下修复胸膜硬化症的肺动脉缺损都可以缓解症状，但由于患者的脆弱性，这些手术的发病率和死亡率都很高。
A hepatic hydrothorax is a pleural effusion that develops in a patient with cirrhosis and portal hypertension in the absence of cardiopulmonary disease. The pleural effusion is derived from ascitic fluid that enters the chest because of the negative pressure within the pleural space via defects in the diaphragm. The peritoneal-to-pleural flow of fluid can be demonstrated by nuclear scanning, even when the ascites is not clinically apparent. The pleural fluid usually has the characteristics of a transudate. However, an occasional patient with hepatic hydrothorax will develop spontaneous bacterial pleuritis manifest by increased pleural fluid neutrophils or a positive bacterial culture and will require antibiotic therapy. Treatment of the hydrothorax is directed at the underlying liver disease but a dyspneic patient can obtain relief from a thoracentesis or paracentesis. When medical therapy fails, liver transplantation is the treatment of choice. Both transjugular intrahepatic portosystemic shunting and thoracoscopic repair of diaphragmatic defects with pleural sclerosis can provide symptomatic relief, but the morbidity and mortality of these procedures are high because of the fragile nature of the patients.