腹水和胸腔积液。79例患者的研究与随访[j]。

M Molina, G Ortega, L Vidal, J J Montoya, A Pérez, B García
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摘要

我们回顾了79例有胸腔积液(EP)和腹水的患者,占982例胸腔积液研究的8%。肝硬化37例(47%)、弥散性癌31例(39.5%)、充血性心力衰竭6例(7%)为主要病因。我们将肝硬化分为两组:A)肝硬化伴水代偿失代偿,12例(15%);B)肝硬化伴以上并发症,25例(31.5%),其中88%为感染性。B组有左侧胸腔积液,积液特征较多,随访3个月生存率低于a组。肿瘤源性积液最常见于卵巢、消化系统、淋巴瘤和来源不明的肿瘤。在恶性积液中,60%胸膜细胞学阳性,55%腹水细胞学阳性。20%的腹膜液和47%的胸腔积液为血清出血性,100%和88%分别为渗出性。肝硬化的腹水为浆液性纤维性渗出物(A组为100%,B组为85.5%),胸腔积液为浆液性纤维性渗出物,但合并感染的病例除外。我们确认胸腔积液和腹水共存的预后不佳。
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[Ascites and pleural effusion. Study and follow-up of 79 patients].

We reviewed 79 patients with a picture of pleural effusion (EP) and ascites, who represented 8% of a total of 982 pleural effusions studied. Liver cirrhosis (CH), 37 cases (47%), disseminated carcinomatosis, 31 cases (39.5%), and congestive heart failure, 6 cases (7%), were the main causes. We made two groups of liver cirrhosis: A) liver cirrhosis with hydropic decompensation, 12 patients (15%), and B) liver cirrhosis with an additional complication added to the above, 25 patients (31.5%), this being infectious in 88% of the cases. In the B group there were cases of left hydrothorax, more features of effusion and a lower survival at 3 months of follow-up than in tha A group. Effusions of neoplastic origin were most frequently seen in tumors of the ovary, digestive system, lymphomas and undetermined origin. In malignant effusions, the cytology was positive in pleura in 60% and in ascites in 55%. Twenty percent of peritoneal fluids and 47% of pleural effusions were serohemorrhagic and 100% and 88%, respectively, were of exudative nature. In liver cirrhosis the ascites was serofibrinous and transudated (100% in group A and 85.5% in B) and the pleural effusion was a serofibrinous transudate except in the cases in which there was an added infection. We confirm the ominous prognosis of the coexistence of pleural effusion and ascites.

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