Han Seul-Ki, Kang Seong-Hee, Kim Moon-Young, Na Seong-Kyun, Kim Taehyung, Lee Minjong, Jun Baek-Gyu, Kim Tae-Suk, Choi Dae-Hee, Suk Ki-Tae, Kim Young-Don, Cheon Gab-Jin, Yim Hyung-Joon, Kim Dong-Joon, Baik Soon-Koo
Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea.
Regenerative Medicine Research Center, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea.
J Clin Med. 2022 Dec 5;11(23):7221. doi: 10.3390/jcm11237221.
Background/Aims: The management of hepatic hydrothorax (HH) remains a challenging clinical scenario with suboptimal options. We investigated the effect and safety of pigtail catheter drainage compared to intermittent thoracentesis. Methods: This multicenter, retrospective study included 164 cirrhotic patients with recurrent pleural effusion from March 2012 to June 2017. Patients with neoplasms, cardiopulmonary disease, and infectious conditions were excluded. We compared the clinical outcomes of pigtail catheter drainage versus thoracentesis for variables including complications related to procedures, overall survival, and re-admission rates. Results: A total of 164 patients were divided into pigtail catheter (n = 115) and thoracentesis (n = 49) groups. During the follow-up period of 6.93 months after discharge, 98 patients died (pigtail; n = 47 vs. thoracentesis; n = 51). The overall survival (p = 0.61) and 30-day mortality (p = 0.77) rates were similar between the pigtail catheter and thoracentesis groups. Only MELD scores were associated with overall survival (adjusted HR, 1.08; p < 0.01) in patients with HH. Spontaneous pleurodesis occurred in 59 patients (51.3%) in the pigtail catheter group. Re-admission rates did not differ between the pigtail catheter and thoracentesis groups (13.2% vs 19.6% p = 0.7). A total of five complications occurred, including four total cases of bleeding (one patient in the pigtail catheter group and three in the thoracentesis group) and one case of empyema in the pigtail catheter group. Conclusions: Pigtail catheter drainage is not inferior to that of intermittent thoracentesis for the management of HH, proving it may be an effective and safe clinical option.
背景/目的：肝性胸腔积液（HH）的管理仍然是一个具有挑战性的临床情况，可供选择的方案并不理想。我们研究了猪尾导管引流与间歇性胸腔穿刺术相比的效果和安全性。方法：这项多中心回顾性研究纳入了2012年3月至2017年6月期间164例复发性胸腔积液的肝硬化患者。排除患有肿瘤、心肺疾病和感染性疾病的患者。我们比较了猪尾导管引流与胸腔穿刺术在包括与操作相关的并发症、总生存率和再入院率等变量方面的临床结果。结果：总共164例患者分为猪尾导管组（n = 115）和胸腔穿刺术组（n = 49）。出院后6.93个月的随访期内，98例患者死亡（猪尾导管组；n = 47 vs. 胸腔穿刺术组；n = 51）。猪尾导管组和胸腔穿刺术组的总生存率（p = 0.61）和30天死亡率（p = 0.77）相似。在HH患者中，只有终末期肝病模型（MELD）评分与总生存率相关（校正风险比，1.08；p < 0.01）。猪尾导管组59例患者（51.3%）发生了自发性胸膜固定术。猪尾导管组和胸腔穿刺术组的再入院率没有差异（13.2%对19.6%，p = 0.7）。总共发生了5例并发症，包括4例出血（猪尾导管组1例患者，胸腔穿刺术组3例）和猪尾导管组1例脓胸。结论：对于HH的管理，猪尾导管引流并不逊于间歇性胸腔穿刺术，证明它可能是一种有效且安全的临床选择。
