Siddappa Pradeep Kumar, Kar Premashish
Department of Medicine, Maulana Azad Medical College, New Delhi 110002, India.
Trop Gastroenterol. 2009 Jul-Sep;30(3):135-41.
Hepatic hydrothorax is defined as significant pleural effusion (usually greater than 500 mL) in a cirrhotic patient, in the absence of underlying pulmonary or cardiac disease. The diagnosis of hepatic hydrothorax should be suspected in a patient with established cirrhosis and portal hypertension, presenting with unilateral pleural effusion, most commonly right-sided. Hydrothorax is uncommon, and is found in 4-6% of all patients with cirrhosis and up to 10% in patients with decompensated cirrhosis. Although ascites is usually present, hydrothorax can occur in the absence of ascites. Patients with hepatic hydrothorax usually have advanced liver disease with portal hypertension and most of them require liver transplantation. Current insight into the pathogenesis of this entity has led to improved treatment modalities such as portosystemic shunts (TIPS) and video-assisted thoracoscopy for closure of diaphragmatic defects. These modalities may provide a bridge towards transplantation.
肝性胸水被定义为肝硬化患者出现的大量胸腔积液（通常大于500毫升），且不存在潜在的肺部或心脏疾病。对于已确诊肝硬化和门静脉高压且出现单侧胸腔积液（最常见于右侧）的患者，应怀疑肝性胸水的诊断。胸水并不常见，在所有肝硬化患者中占4% - 6%，在失代偿期肝硬化患者中高达10%。虽然通常存在腹水，但胸水也可在无腹水的情况下发生。肝性胸水患者通常患有晚期肝病并伴有门静脉高压，其中大多数需要肝移植。目前对该病症发病机制的深入了解已带来了诸如门体分流术（经颈静脉肝内门体分流术）和电视辅助胸腔镜检查以闭合膈肌缺损等改进的治疗方式。这些方式可为肝移植提供过渡。
