肝性胸水：综述
Hepatic Hydrothorax: A Review.
作者信息
Ismail Abdellatif, Awadalla Mohanad, Pothuraju Suvisesh, Singal Ashwani K
机构信息
Department of Internal Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, MD, USA.
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
出版信息
Curr Hepatol Rep. 2025 Dec;24(1). doi: 10.1007/s11901-025-00677-8. Epub 2025 Feb 14.
PURPOSE OF THE REVIEW
To review epidemiology, pathogenesis, diagnosis, and management of hepatic hydrothorax.
RECENT FINDINGS
Refractory hepatic hydrothorax is an independent predictor of mortality in patients with decompensated cirrhosis. Allocation of Model for End-Stage Liver Disease exception points for patients with refractory hydrothorax was found to be associated with a significant reduction in post liver transplant mortality.
SUMMARY
Hepatic hydrothorax, pleural effusion in patients with decompensated liver cirrhosis without primary pleural and cardiopulmonary pathology is associated with a high rate of morbidity and mortality. Pathogenesis is a combination of salt and water retention and unidirectional movement of fluid from the peritoneal to the thoracic cavity. Diagnosis relies on pleural fluid analysis and ruling out a primary pleural and cardiopulmonary pathology. Management is complex and requires a stepwise and multidisciplinary approach. All patients with refractory hydrothorax should be evaluated for liver transplant.
综述目的
综述肝性胸水的流行病学、发病机制、诊断及管理。
最新发现
难治性肝性胸水是失代偿期肝硬化患者死亡的独立预测因素。发现为难治性胸水患者分配终末期肝病模型例外点数与肝移植后死亡率显著降低相关。
总结
肝性胸水，即无原发性胸膜和心肺病变的失代偿期肝硬化患者出现的胸腔积液，与高发病率和死亡率相关。发病机制是盐和水潴留以及液体从腹腔单向移动至胸腔的综合作用。诊断依赖于胸腔积液分析并排除原发性胸膜和心肺病变。管理复杂，需要采取逐步且多学科的方法。所有难治性胸水患者均应评估是否适合肝移植。
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