The Outcome of Thoracentesis versus Pigtail catheter for Hepatic Hydrothorax = The Outcome of Thoracentesis versus Pigtail catheter for Hepatic Hydrothorax

다국어 초록 (Multilingual Abstract)

Aims: Hepatic hydrothorax (HH) is a rare complication and associated with poor clinical outcome in patients with cirrhosis. Conservative management for HH includes salt restriction and administration of diuretics, often with percutaneous drainage; thoracentesis, catheter drainage, and chest tube drainage. Therapeutic thoracentesis is a simple that can provide rapid relief of symptoms though it is temporary and repeated. We aimed to evaluate the efficacy and safety the use of pigtail catheters insertion compared to intermittent thoracentesis.
Methods: This multicenter retrospective study included 136 cirrhotic patients with pleural fluid from March 2012 to June 2017. Cirrhosis patients with transudate pleural effusion greater than 500ml are included, other neoplasm and cardiopulmonary disease and infectious condition were excluded.
Results: There were 115 cases of pigtail catheter insertion and 25 cases of intermittent thoracentesis. The mean MELD scores of the enrolled patients were 19.71 ± 7.85 and 21.57 ±8.39, respectively (P=0.32). The median catheter dwelling time was 8 days in pigtail catheter group. Spontaneous pleurodesis was occurred in 59 cases (51%) in pigtail group. Bleeding complica tion and empyema were occurred in pigtail group. The median hospitalization period was 19 day in pigtail group and 31 day in thoracentesis group (P=0.83). The overall 1-year mortality for patients treated with pigtail catheter insertion versus thoracentesis was 40.9% (n=47) and 71.4% (n=15), respectively. There was no difference in survival rate between pigtail catheter group and thoracentesis group (P=0.19). Re-admission rate for 1 year did not differ between pigtail catheter insertion group and thoracentesis group (50.1% vs. 37%, P=0.38).
Conclusions: Pigtail catheter insertion can safely obviate the need for repeated thoracentesis and may be recommended for management of hepatic hydrothorax.