Nakamura Sota, Yoshiya Shohei, Ito Kensaku, Yamamoto Noriaki, Kawada Ippei, Tada Kazuhiro, Kuroda Yosuke, Yoshizumi Fumitaka, Kouso Hidenori, Iwaki Kentaro, Hiroshige Shoji, Takeuchi Hideya, Yamashita Yo-Ichi, Fukuzawa Kengo, Yoshizumi Tomoharu
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan.
Department of Surgery, Oita Red Cross Hospital, Oita, Oita, Japan.
Surg Case Rep. 2025;11(1). doi: 10.70352/scrj.cr.25-0280. Epub 2025 Sep 6.
Pleuroperitoneal communication (PPC) is an abnormal connection between the thoracic and abdominal cavities, allowing ascitic fluid to migrate into the pleural space and cause pleural effusion. Although PPC is a recognized complication in peritoneal dialysis patients, it is rarely reported as a postoperative complication.
A 54-year-old female patient with a history of right hemicolectomy and right hepatectomy for ascending colon cancer and metastatic liver tumor developed persistent right pleural effusion 3 months postoperatively. She also had ovarian metastases, peritoneal dissemination, and malignant ascites. Despite treatment with diuretics and 2 attempts at pleurodesis, the pleural effusion persisted. A combined thoracoscopic and laparoscopic approach was performed. Intraoperatively, a diaphragmatic hernia with a pinhole defect was identified, suggesting migration of ascitic fluid into the thoracic cavity. Resection of the hernia sac and suture closure of the diaphragmatic defect were carried out. Postoperatively, the pleural effusion resolved, and her dyspnea improved.
In case of refractory pleural effusion following hepatectomy, PPC due to diaphragmatic defects should be considered, particularly in the presence of ascites. A combined thoracoscopic and laparoscopic approach is a viable surgical option for definitive treatment.
胸膜腹膜交通（PPC）是胸腔与腹腔之间的一种异常连接，可使腹水进入胸腔并导致胸腔积液。尽管PPC是腹膜透析患者公认的并发症，但作为术后并发症却鲜有报道。
一名54岁女性患者，因升结肠癌和转移性肝肿瘤接受了右半结肠切除术和右肝切除术，术后3个月出现持续性右侧胸腔积液。她还伴有卵巢转移、腹膜播散和恶性腹水。尽管使用了利尿剂治疗并进行了2次胸膜固定术尝试，但胸腔积液仍持续存在。遂采用胸腔镜和腹腔镜联合手术方法。术中发现一个有针孔样缺损的膈疝，提示腹水已进入胸腔。切除疝囊并缝合关闭膈肌缺损。术后，胸腔积液消退，患者呼吸困难改善。
肝切除术后出现难治性胸腔积液时，应考虑因膈肌缺损导致的PPC，尤其是存在腹水的情况下。胸腔镜和腹腔镜联合手术方法是确定性治疗的可行手术选择。
