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Various Treatment Modalities in Hepatic Hydrothorax: What Is Safe and Effective?

Yonsei Medical Journal 2019년 60권 10호 p.944 ~ 951
 ( Yoon Jae-Hyun ) - Chonnam National University Medical School Chonnam National University Hospital Department of Internal Medicine

 ( Kim Hee-Joon ) - Chonnam National University Medical School Chonnam National University Hospital Department of Surgery
 ( Jun Chung-Hwan ) - Chonnam National University Medical School Chonnam National University Hospital Department of Internal Medicine
 ( Cho Sung-Bum ) - Chonnam National University Medical School Chonnam National University Hwasun Hospital Department of Internal Medicine
 ( Jung Yo-Chun ) - Chonnam National University Medical School Chonnam National University Hospital Department of Thoracic and Cardiovascular Surgery
 ( Choi Sung-Kyu ) - Chonnam National University Medical School Chonnam National University Hospital Department of Internal Medicine

Abstract


Purpose: Hepatic hydrothorax is a complication of decompensated liver cirrhosis that is difficult and complex to manage. Data concerning the optimal treatment method, other than liver transplantation, are limited. This study aimed to compare the clinical features and outcomes of patients treated with various modalities, while focusing on surgical management and pigtail drainage.

Materials and Methods: Forty-one patients diagnosed with refractory hepatic hydrothorax between January 2013 and December 2017 were enrolled.

Results: The mean Child-Turcotte-Pugh and model for end stage liver disease scores of the enrolled patients were 10.1 and 19.7, respectively. The patients underwent four modalities: serial thoracentesis (n=11, 26.8%), pigtail drainage (n=16, 39.0%), surgery (n=10, 24.4%), and liver transplantation (n=4, 9.8%); 12-month mortality rate/median survival duration was 18.2%/868 days, 87.5%/79 days, 70%/179 days, and 0%/601.5 days, respectively. Regarding the management of refractory hepatic hydrothorax, surgery group required less frequent needle puncture (23.5 times in pigtail group vs. 9.3 times in surgery group), had a lower occurrence of hepatorenal syndrome (50% vs. 30%), and had a non-inferior cumulative overall survival (402.1 days vs. 221.7 days) compared to pigtail group. On multivariate analysis for poor survival, body mass index <19 kg/m2, refractory hepatic hydrothorax not managed with liver transplantation, Child-Turcotte-Pugh score >10, and history of severe encephalopathy (grade >2) were associated with poor survival.

Conclusion: Serial thoracentesis may be recommended for management of hepatic hydrothorax and surgical management can be a useful option in patients with refractory hepatic hydrothorax, alternative to pigtail drainage.

키워드

Cirrhosis; drainage; hydrothorax; surgery
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