The successful treatment of symptomatic, refractory hepatic hydrothorax with transjugular intrahepatic portosystemic shunt
The successful treatment of symptomatic, refractory hepatic hydrothorax with transjugular intrahepatic portosystemic shunt
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DOI：
10.1002/hep.510250611
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发表时间：
1997-06-01
期刊：
影响因子：
13.5
通讯作者：
Trey, C
中科院分区：
文献类型：
--
作者：
Gordon, FD;Anastopoulos, HT;Trey, C
肝性胸水是门静脉高压症的一种罕见并发症，保守治疗可能成功，但难治性肝性胸水并不少见，难治性胸水的治疗通常无效，并可导致临床状况恶化，经颈静脉肝内门体分流术（TIPS）降低门静脉压力，已用于治疗难治性腹水，为探讨TIPS治疗难治性肝性胸水的疗效，对24例难治性肝性胸水患者行TIPS治疗。Child/Pugh B级5例（20.8%），C级19例（79.2%）。所有患者均接受了多次胸腔穿刺术，并出现低白蛋白血症。平均随访时间为7.2个月（范围：0.25-49个月），24例患者中有14例（58.3%）在分流管置入后症状完全缓解，不需要进一步的胸腔穿刺术，另外5例（20.8%）患者需要较少的胸腔穿刺术。五（20.8%）患者出现肝功能恶化并在45天内死亡，随访≥ 60天的12例患者中，66.7%的患者血清白蛋白平均升高1.2 g/dL（范围，0.1-2.2 g/dL），这12例患者中有7例（58.3%）的Child's Pugh评分改善，2例患者从C级改善为A级。这两个病人不再需要肝移植，这项研究表明，TIPS可以有效地管理症状，难治性肝性胸水，临床和实验室改善，肝移植可能成为不必要的。
Hepatic hydrothorax is a rare complication of portal hypertension, Conservative therapy may be successful but refractory hepatic hydrothorax is not uncommon, Management of refractory hydrothorax is usually ineffective and can result in a worsened clinical status, Transjugular intrahepatic portosystemic shunts (TIPS) lower portal pressure and have been used in the treatment of refractory ascites, The aim of this study was to determine the efficacy of TIPS in the treatment of symptomatic refractory hepatic hydrothorax, A TIPS was placed in 24 consecutive cirrhotic patients with symptomatic refractory hepatic hydrothorax. Five patients (20.8%) were Child's/Pugh class B and 19 (79.2%) were class C. All had undergone multiple thoracenteses and were hypoalbuminemic. Mean follow-up was 7.2 months (range, 0.25-49 months), Fourteen (58.3%) of 24 patients had complete relief of symptoms after shunt placement and did not require further thoracentesis, Five (20.8%) additional patients required fewer thoracenteses. Five (20.8%) patients developed worsening Liver function and died within 45 days, In eight (66.7%) of 12 patients with greater than or equal to 60 days of follow-up, the serum albumin increased by a mean of 1.2 g/dL (range, 0.1-2.2 g/dL), The Child's-Pugh score improved in 7 (58.3%) of these 12 patients and two patients improved from class C to class A. These two patients no longer require liver transplantation, This study shows that TIPS can be effective in the management of Symptomatic, refractory hepatic hydrothorax, Clinical and laboratory improvement may be seen and liver transplantation may become unnecessary.