Chemical pleurodesis in patients with hepatic hydrothorax; management, morbidity and mortality/Hepatik hidrotoraksli hastalarda kimyasal plorodezis; yaklasim, mortalite ve morbidite

Objective: Chemical pleurodesis in an effective treatment for malignant effusion and pneumothorax. Although this mode of therapy is less widely accepted in the treatment of patients with hepatic hydrothorax, the need for palliative treatment in such patients encouraged us to analyze the outcome of chemical pleurodesis using bovoiodine, vibramycin and talc slurry in the treatment of hepatic hydrothorax. Material and Method: A prospective study including 23 patients with symptomatic right side hepatic hydrothorax not responding to medical treatment and repeated thoracocenthesis was carried out. From March 2007 through March 2008, 19 men and 4 women with a mean age of 54.3 [+ or -] 8.1 years (range 42-70 years) underwent medical thosacoscopies to achieve pleurodesis by application of 3 sclerosing agents. Results: Of the 23 patients pleurodesis was repeated in 20 cases. Three cases were lost during the 3 months follow up period of the study. The procedure was effective in 15 of 20 patients (75%), 7/8 cases treated by bovoiodine (87.5%), 4/6 cases with vibramycin and talc slurry (66.7%) for each. There were 4 recurrences (20%) and a single case of mortality (5%) due to hepatic coma attributable to the course of the disease. We detected minimal morbidity during the follow up period of 3 months. Conclusion: The procedure appears to be indicated for these fragile patients especially when medical therapy fails. Since efficacy was 75%, chemical pleurodesis deserves to be considered as an alterative therapy in such patients. (Tug Toraks Des 2009, 70:772-7) Key words: Hepatic hydrothorax, pleurodesis, chemical sclerosing agents Amac: Kimyasal plorodez malign effuzyon ve pnomotoraks tedavisinde kullanilan etkin bir yontemdir. Ancak, hepatik hidrotoraksli hastalarin tedavisinde daha az kabul edilmektedir. Buna ragmen, halen hepatik hidrotoraksli hastalarin palyasyonunda; bovoiodin, vibramisin ve talk ile yapilan kimyasal plorodez tedavisinin kullanilmasi, bizi bu calismayi yapmaya yoneltmistir. Gerec ve Yontem: Medikal tedaviye yanit vermeyen, tekrarlayan plorodez ihtiyaci olan ve semptomatik hepatik hidrotoraksli 23 olgu, prospektif olarak, calismaya dahil edildi. Mart 2007-Mart 2008 tarihleri arasinda ortalama yasi 54.3[+ or -]8.1 yil (42-70 arasinda) olan, 19'u erkek ve 4'u kadin hastalara, medikal torakoskopi uygulandi ve 3 sklerozan ajan kullanilarak plorodez yapildi. Bulgular: 23 hastanin 20' singe plorodezis tekrarlandi. Uc aylik takip suresinde 3 hasta kaybedild