Molina M, Ortega G, Vidal L, Montoya J J, Pérez A, García B
Rev Esp Enferm Apar Dig. 1989 Oct;76(4):375-8.
We reviewed 79 patients with a picture of pleural effusion (EP) and ascites, who represented 8% of a total of 982 pleural effusions studied. Liver cirrhosis (CH), 37 cases (47%), disseminated carcinomatosis, 31 cases (39.5%), and congestive heart failure, 6 cases (7%), were the main causes. We made two groups of liver cirrhosis: A) liver cirrhosis with hydropic decompensation, 12 patients (15%), and B) liver cirrhosis with an additional complication added to the above, 25 patients (31.5%), this being infectious in 88% of the cases. In the B group there were cases of left hydrothorax, more features of effusion and a lower survival at 3 months of follow-up than in tha A group. Effusions of neoplastic origin were most frequently seen in tumors of the ovary, digestive system, lymphomas and undetermined origin. In malignant effusions, the cytology was positive in pleura in 60% and in ascites in 55%. Twenty percent of peritoneal fluids and 47% of pleural effusions were serohemorrhagic and 100% and 88%, respectively, were of exudative nature. In liver cirrhosis the ascites was serofibrinous and transudated (100% in group A and 85.5% in B) and the pleural effusion was a serofibrinous transudate except in the cases in which there was an added infection. We confirm the ominous prognosis of the coexistence of pleural effusion and ascites.
我们回顾了79例有胸腔积液(EP)和腹水表现的患者,这些患者占所研究的982例胸腔积液患者的8%。主要病因包括肝硬化(CH)37例(47%)、播散性癌31例(39.5%)和充血性心力衰竭6例(7%)。我们将肝硬化患者分为两组:A组)伴有水钠潴留失代偿的肝硬化患者12例(15%);B组)除上述情况外还伴有其他并发症的肝硬化患者25例(31.5%),其中88%的病例伴有感染。B组中出现左侧胸腔积液的病例较多,积液特征更明显,且随访3个月时的生存率低于A组。肿瘤性胸腔积液最常见于卵巢肿瘤、消化系统肿瘤、淋巴瘤及来源不明的肿瘤。在恶性胸腔积液中,胸膜细胞学检查阳性率为60%,腹水细胞学检查阳性率为55%。20%的腹腔积液和47%的胸腔积液为血清血性,分别有100%和88%为渗出性。肝硬化患者的腹水为浆液纤维蛋白性漏出液(A组100%,B组85.5%),胸腔积液为浆液纤维蛋白性漏出液,但伴有感染的病例除外。我们证实了胸腔积液和腹水并存的预后不良。