Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Shiga, Japan.
Department of Obstetrics and Gynecology, National Hospital Organization Higashi-ohmi General Medical Center, Higashiomi, Shiga, Japan.
J Obstet Gynaecol Res. 2024 Apr;50(4):734-739. doi: 10.1111/jog.15882. Epub 2024 Jan 9.
Pleuroperitoneal communication poses a respiratory failure risk due to pleural fluid accumulation with thoracic migration of ascites. Here, we discuss the following cases: Case 1: A woman was diagnosed with a ruptured ovarian tumor with right pleural fluid and ascites, without respiratory failure. Ovarian cystectomy was performed with inadequate removal of ascites. Postoperatively, respiratory failure occurred, and thoracentesis detected pleural fluid resembling ascites. Case 2: A woman was diagnosed with a ruptured ectopic pregnancy with right pleural fluid and ascites without respiratory failure. A diagnosis of clinical pleuroperitoneal communication was considered based on computed tomography findings. During laparoscopic salpingectomy, high-pressure ventilation was performed to push the pleural fluid back into the abdominal cavity; a negative-pressure drain was inserted, and the ascites was completely removed. Postoperative radiography revealed the absence of pleural fluid. Therefore, a preoperative diagnosis of clinical pleuroperitoneal communication and appropriate intraoperative techniques can prevent postoperative respiratory failure.
由于胸腔内积聚的胸水随着腹水向胸腔迁移，因此会导致呼吸困难。这里，我们讨论以下两种情况：
病例 1：一位女性被诊断为卵巢肿瘤破裂，伴有右侧胸腔积液和腹水，但没有出现呼吸衰竭。进行了卵巢囊肿切除术，但未能充分清除腹水。术后，该女性出现呼吸衰竭，胸腔穿刺检测到类似腹水的胸水。
病例 2：一位女性被诊断为异位妊娠破裂，伴有右侧胸腔积液和腹水，没有呼吸衰竭。根据 CT 检查结果，考虑临床性胸腹沟通的诊断。在腹腔镜输卵管切除术期间，通过高压通气将胸腔积液推回腹腔，并插入负压引流管，完全清除腹水。术后放射影像学显示胸腔积液消失。因此，术前对临床性胸腹沟通的诊断和术中适当的技术可以预防术后呼吸衰竭。
