Christine Argento A, Kim Anthony, Knauert-Brown Melissa, Boffa Daniel, Siegel Mark D, Jafari Behrouz, Puchalski Jonathan T
Divisions of *Pulmonary, Critical Care and Sleep Medicine †Thoracic Surgery ‡Thoracic Interventional Program, Yale University School of Medicine, New Haven, CT.
J Bronchology Interv Pulmonol. 2014 Apr;21(2):150-3. doi: 10.1097/LBR.0000000000000047.
Pleural effusions may result from intra-abdominal processes and sometimes present with dramatic clinical consequences. We present 2 cases of recurrent hydrothorax requiring surgical repair of diaphragmatic defects and describe when surgery may be the best treatment modality.
PATIENT 1: : A 63-year-old man with end-stage renal disease requiring peritoneal dialysis presented with dyspnea on exertion that progressed to cardiac arrest. He was found to have a tension hydrothorax that was initially stabilized with thoracentesis and tube thoracostomy. He eventually underwent surgical repair of fenestrations with complete resolution of his effusion. PATIENT 2:: A 52-year-old man with recurrent hydrothorax in the context of hepatitis C cirrhosis and hepatocellular carcinoma following radiofrequency ablation to his liver had recurrent admissions with dyspnea and a large pleural effusion. When medical therapy failed, he underwent surgical repair of a large diaphragmatic defect.
Hydrothorax related to peritoneal dialysis or cirrhosis may cause life-threatening scenarios in which medical management may stabilize the patient. Ultimately, surgical corrections of diaphragmatic defects may be necessary for definitive management in selected patients. Although these scenarios are rare, clinicians should be aware of these possibilities as early collaboration between medical and surgical services is essential for optimal patient care.
胸腔积液可能由腹腔内病变引起，有时会导致严重的临床后果。我们报告2例复发性胸腔积液需要手术修复膈肌缺损的病例，并描述何时手术可能是最佳治疗方式。
病例1：一名63岁终末期肾病患者，需要进行腹膜透析，出现劳力性呼吸困难，进而发展为心脏骤停。他被发现患有张力性胸腔积液，最初通过胸腔穿刺和胸腔闭式引流得以稳定。他最终接受了开窗修复手术，胸腔积液完全消退。病例2：一名52岁男性，在丙型肝炎肝硬化和肝细胞癌背景下，肝脏接受射频消融术后出现复发性胸腔积液，因呼吸困难和大量胸腔积液反复入院。药物治疗失败后，他接受了大的膈肌缺损修复手术。
与腹膜透析或肝硬化相关的胸腔积液可能导致危及生命的情况，药物治疗可使患者病情稳定。最终，对于部分患者，膈肌缺损的手术矫正可能是确定性治疗所必需的。尽管这些情况罕见，但临床医生应意识到这些可能性，因为内科和外科服务的早期协作对于优化患者护理至关重要。
