The Characteristics And Clinical Analysis Of Hepatic Pleural Effusion

Background: Hepatic pleural effusion is a complication of advanced liver cirrhosis. It is a rare and difficult complication. Liver cirrhosis cause portal hypertension, low serum albumin, hormone changes, and so on, these factors formed the ascites, ascites through the diaphragm to move to the pleural cavity, this called hepatic pleural effusion. The aim of our study was to learn the clinical features of hepatic pleural effusion.Methods: Clinical data sources origin cirrhosis patients from the Digestive Department of Gansu Province People’s Hospital(2012.01.01- 2015.08.01) and Infectious Disease of Lanzhou University First Hospital(2014.10.01-2015.08.31). According to the diagnostic criteria of hepatic hydrothorax, there are 41 cases from 841 cirrhosis patients were diagnosed with hepatic pleural effusion. The pathological and physiological, clinical manifestations, diagnosis, intervention and treatment results were described and analyzed..Results: The incidence of hepatic hydrothorax was 5%(41/841), shortness of breath, dyspnea and chest pain is the most prominent symptom. Pleural effusion was the most commonly occurred in the right side of the pleural(27 / 41; 66%), followed by bilateral thoracic(12 / 41; 29%) and left pleural(2 / 41; 5%).There are 2(2 / 41;5%) patients were not detected in ascites. In the selected 41 patients, 12 cases were carried out pleural effusion test, The serum and pleural effusion biochemical examination prompted: mostly pleural effusion were transudate(11 / 12, 92%), only 1 case was exudate(1/12,8%), the possible reason is bacterial empyema. The most basic treatment for hepatic pleural effusion was diuretic therapy, and all 41 patients received initial diuretic therapy. Most of the patients(27/41, 66%) had a better response to diuretics. Pleural effusion relieved after 12 cases(12/41,29%) were treated by pleural puncture or pleural catheter drainage. There were 2 cases(2/41,5%) were treated with pleural fixation. The diuretic has a poor effective in a minority of patients(2/41,5%),the repeated pleural puncture developed refractory hepatic pleural effusion and eventually progress for hepatocellular carcinoma(HCC), lost the chance of operation.Conclusion: The incidence of hepatic pleural effusion is almost identical with that reported in literatures. The incidence rate is low. It is a rare and difficult complication of cirrhosis. Pleural effusion occurred mainly in the right pleural, nature mostly is transudate. The aggressive diuretic and thoracic puncture or thoracic duct drainage is the basic initial treatment. The majority of patients after diuretics and thoracentesis have a good reaction.Refractory hepatic hydrothorax can alleviate the symptoms by surgical intervention, but because of less clinical cases, large surgical risks and complications, only a minority of patients can undergo surgical operation.So there was no unified and clear outcome for surgical intervention. Therefore, the research about hepatic hydrothorax have limitations.