Prevention and management of pleural effusion following hepatectomy in primary liver cancer.
BACKGROUND
Postoperative pleural effusion occurs frequently after hepatectomy. The risk factors, prevention and management of postoperative pleural effusion in patients with primary liver cancer (PLC) who have undergone hepatectomy and the value of the argon beam coagulator (ABC) for the prevention of pleural effusion are studied.


METHODS
A total of 523 patients with PLC at our institution who had had right hepatectomy from July 2000 to June 2004 were studied retrospectively. Comparative analysis was made to identify the factors contributing to postoperative pleural effusion and the efficacy of various managements.


RESULTS
Of the 523 patients whose livers were dissociated using argon beam cutting and/or coagulation, 20(3.8%) developed pleural effusions; whereas in the other 467 patients underwent hepatectomy with suture ligation of the diaphragmatic secondary wound surface during the same period, 49(10.5%) had pleural effusion (P < 0.01). The factors contributing to postoperative pleural effusion included subphrenic collection, postoperative hepatic insufficiency with ascites, duration of hepatic occlusion and underlying cirrhosis.


CONCLUSIONS
Dissociation of the liver by argon beam cutting and/or coagulation can save suture ligation of the diaphragmatic secondary wound surface and may also prevent postoperative pleural effusion. Pleural drainage using an indwelling central-venous-catheter (CVC) in the pleural cavity is safe and efficacious.
Yan
Jian-Jun
JJ
Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China. Yiqunyan@21cn.com
Zhang
Xiang-Hua
XH
Chu
Kai-Jian
KJ
Huang
Liang
L
Zhou
Fei-Guo
FG
Yan
Yi-Qun
YQ
D000328:Adult; D000368:Aged; D001128:Argon; D002405:Catheterization, Central Venous; D004322:Drainage; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D017075:Laser Coagulation / Q000592:standards; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors
D001128:Argon