臨床上較常見的難治頑固性肋膜積水包含肝性肋膜積水（hepatic hydrothorax )、乳糜胸(chylothorax)與惡性肋膜積水（malignant pleural effusion)，通常因潛在難以矯治的病因且在短時間内蓄積大量積液而引發持續的症狀。建議的處置方式與一般肋膜腔積液不同，常需要合併内外科的治療。

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.