World J Gastroenterol. 2011 Aug 28;17(32):3759-60. doi: 10.3748/wjg.v17.i32.3759.
A pancreatic pleural effusion may result from a pancreatopleural fistula. We herein discuss two interesting issues in a similar case report of a pleural effusion caused after splenectomy, which was recently published in the World Journal of Gastroenterology. Pancreatic exudate passes directly through a natural hiatus in the diaphragm or by direct penetration through the dome of the diaphragm from a neighboring subdiaphragmatic collection. The diaphragmatic lymphatic "stomata" does not contribute to the formation of such a pleural effusion, as it is inaccurately mentioned in that report. A strictly conservative approach is recommended in that article as the management of choice. Although this may be an option in selected frail patients, there has been enough accumulative evidence that a pancreaticopleural fistula may be best managed by early endoscopy in order to avoid complications causing prolonged hospitalization.
胰腺胸腔积液可由胰胸膜瘘引起。我们在此讨论了一篇近期发表在《世界胃肠病学杂志》上的类似胸腔积液病例报告中的两个有趣问题。胰液渗出物直接穿过横膈膜的天然裂孔，或通过直接穿透横膈膜顶部从相邻的膈下积液处穿透。横膈膜淋巴“孔”不会促成这种胸腔积液的形成，正如该报告中不准确提到的那样。该文章建议采用严格的保守方法作为首选治疗方法。尽管对于某些虚弱的患者来说这可能是一种选择，但已经有足够的累积证据表明，为了避免导致住院时间延长的并发症，最好通过早期内镜来治疗胰瘘。
