Rahim Y, Reddy R V, Naeem M, Tsaknis G
Department of Respiratory Medicine, Kettering General Hospital, Kettering, UK.
Respir Med Case Rep. 2024 May 16;50:102039. doi: 10.1016/j.rmcr.2024.102039. eCollection 2024.
Medical thoracoscopy with chemical pleurodesis is a last resort for managing patients who suffer. from recurrent hepatic hydrothorax. However, despite pleurodesis, the rapid fluid build-up can hinder the successful apposition of the pleural surfaces. To improve the chances of success, we investigated the effectiveness of abdominal paracentesis before chemical pleurodesis via medical thoracoscopy to reduce significant fluid shifts from the peritoneal to the pleural cavity. We present a series of three patients with liver cirrhosis complicated by hepatic hydrothorax who underwent medical thoracoscopy with talc pleurodesis. Before the procedure, we optimised medical treatment, and if needed, we performed large-volume paracentesis to prevent rapid reaccumulation of pleural fluid. All study subjects achieved treatment success, defined as relief of breathlessness and absence of pleural effusion at 12 months. Complications related to the treatment included hepatic encephalopathy and acute kidney injury, which were managed conservatively. To manage symptomatic and recurrent hepatic hydrothorax, medical thoracoscopy with talc pleurodesis, preceded by the evacuation of ascites, can be considered as a treatment option. This procedure should be considered early for those who do not respond to medical management and are not suitable candidates for TIPS or liver transplantation.
内科胸腔镜联合化学性胸膜固定术是治疗复发性肝性胸水患者的最后手段。然而，尽管进行了胸膜固定术，但胸水的快速积聚仍会阻碍胸膜表面的成功贴合。为提高成功率，我们研究了在内科胸腔镜下进行化学性胸膜固定术前进行腹腔穿刺放液，以减少从腹腔到胸腔的大量液体转移的有效性。我们报告了3例肝硬化合并肝性胸水的患者，他们接受了滑石粉胸膜固定术的内科胸腔镜检查。在手术前，我们优化了内科治疗，如有必要，我们进行了大量腹腔穿刺放液，以防止胸水快速再积聚。所有研究对象均取得了治疗成功，定义为在12个月时呼吸困难缓解且无胸腔积液。与治疗相关的并发症包括肝性脑病和急性肾损伤，均采取保守治疗。对于有症状的复发性肝性胸水，可考虑在内科胸腔镜下进行滑石粉胸膜固定术，并在术前抽放腹水，作为一种治疗选择。对于那些对内科治疗无反应且不适合经颈静脉肝内门体分流术（TIPS）或肝移植的患者，应尽早考虑这一手术。
