並列摘要
Rapidly recurrent, symptomatic pleural effusions remain the major challenge to clinical physician. The content of this article includes the clinical features and management of three most common of refractory pleural effusions. Hepatic hydrothorax arises in patients with chronic liver diseases. With the character of rapid re-accumulation after thoracentesis or tube drainage, it demands combined medical and surgical treatment. Thoracoscopic pleurodesis, pleural abrasion adjunct with chemical sclerotic agents, or application of pleural flap and mesh onlay reinforcement have been advised. Malignant effusion needs multi-modality approach. The 30-day mortality rate after pleurodesis is often reported as more than 10% due to the presence of advanced malignant disease and other comorbidities. Nutrition loss and immune depletion are the major concern of chylothorax. It is worrisome that malnutrition, severe infection and symptomatic dyspnea occurred in a large population of patients. The above conditions should not rely on tube drainage only, as it would bring disaster rather than clinical benefits. Rapid, efficient management makes prognosis different.