Alberts W M, Salem A J, Solomon D A, Boyce G
Division of Pulmonary, Critical Care, and Occupational Medicine, University of South Florida College of Medicine, Tampa.
Arch Intern Med. 1991 Dec;151(12):2383-8.
Significant pleural effusions are infrequently noted in patients with cirrhosis of the liver. A large effusion (hepatic hydrothorax) occasionally appears during the course of the disease. The fluid in the pleural space is believed to be derived from ascitic fluid that may accompany hepatic cirrhosis. Although the exact mechanism is somewhat controversial, it appears that the ascitic fluid is transported directly into the pleural space. A therapeutic thoracentesis, usually accompanied by a paracentesis, may be necessary to relieve acute symptoms. Long-term management, however, centers around eliminating or reducing the formation of ascites. When this is not successful, tube thoracostomy followed by chemical pleurodesis, primary repair of diaphragmatic defects with pleural sclerosis, or peritoneovenous shunting in conjunction with chemical pleurodesis may be attempted. These interventions may or may not be successful. Management of hepatic hydrothorax remains a clinical challenge.
肝硬化患者很少出现大量胸腔积液。在疾病过程中偶尔会出现大量积液（肝性胸水）。胸腔内的液体被认为来源于可能伴随肝硬化出现的腹水。尽管确切机制存在一定争议，但腹水似乎是直接进入胸腔的。为缓解急性症状，可能需要进行治疗性胸腔穿刺术，通常还会同时进行腹腔穿刺术。然而，长期管理的重点是消除或减少腹水的形成。如果这一方法不成功，可以尝试进行胸腔置管引流，随后进行化学性胸膜固定术、伴有胸膜硬化的膈肌缺损一期修复术，或结合化学性胸膜固定术的腹腔静脉分流术。这些干预措施可能成功，也可能不成功。肝性胸水的管理仍然是一项临床挑战。
