Hou Feifei, Qi Xingshun, Guo Xiaozhong
Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Shenyang Military Area, No. 83 Wenhua Road, Shenyang, 110840, China.
Postgraduate College, Liaoning University of Traditional Chinese Medicine, Shenyang, China.
Dig Dis Sci. 2016 Nov;61(11):3321-3334. doi: 10.1007/s10620-016-4260-9. Epub 2016 Jul 25.
Hepatic hydrothorax (HH) is a serious complication of end-stage liver diseases, which is associated with poor survival. There is no consensus regarding the treatment of HH.
To evaluate the effectiveness and safety of pleurodesis for HH in a systematic review with meta-analysis.
All relevant papers were searched on the EMBASE and PubMed databases. As for the data from the eligible case reports, the continuous data were expressed as the median (range) and the categorical data were expressed as the frequency (percentage). As for the data from the eligible case series, the rates of complete response and complications were pooled. The proportions with 95 % confidence intervals (CIs) were calculated by using random-effect model.
Twenty case reports including 26 patients and 13 case series including 180 patients were eligible. As for the case reports, the median age was 55 years (range 7-78) and 15 patients were male. The prevalence of ascites was 76 % (19/25). Seventeen (65.38 %) patients responded favorably to pleurodesis. As for the case series, the mean age was 51.5-63.0 years and 83 patients were male. The pooled prevalence of ascites was 90 % (95 % CI 81-97 %) in 7 studies including 71 patients. The complete response rate after pleurodesis was reported in all studies, and the pooled rate was 72 % (95 % CI 65-79 %). Complications related to pleurodesis were reported in 6 studies including 63 patients, and the pooled rate was 82 % (95 % CI 66-94 %).
Pleurodesis may be a promising treatment for HH, but carries a high rate of complications.
肝性胸水（HH）是终末期肝病的严重并发症，与生存率低相关。关于HH的治疗尚无共识。
通过系统评价和荟萃分析评估胸膜固定术治疗HH的有效性和安全性。
在EMBASE和PubMed数据库中检索所有相关论文。对于符合条件的病例报告数据，连续数据以中位数（范围）表示，分类数据以频率（百分比）表示。对于符合条件的病例系列数据，汇总完全缓解率和并发症发生率。采用随机效应模型计算95%置信区间（CI）的比例。
纳入20篇病例报告（共26例患者）和13篇病例系列（共180例患者）。病例报告中，中位年龄为55岁（范围7 - 78岁），15例为男性。腹水患病率为76%（19/25）。17例（65.38%）患者对胸膜固定术反应良好。病例系列中，平均年龄为51.5 - 63.0岁，83例为男性。7项研究（共71例患者）中腹水的汇总患病率为90%（95%CI 81 - 97%）。所有研究均报告了胸膜固定术后的完全缓解率，汇总率为72%（95%CI 65 - 79%）。6项研究（共63例患者）报告了与胸膜固定术相关的并发症，汇总率为82%（95%CI 66 - 94%）。
胸膜固定术可能是治疗HH的一种有前景的方法，但并发症发生率高。
