Lee A, Lau T N, Yeong K Y
Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore.
Support Care Cancer. 2000 Nov;8(6):493-9. doi: 10.1007/s005200000139.
Paracentesis is widely employed for palliation of symptomatic malignant ascites. In some patients, there is rapid re-accumulation of fluid necessitating frequent repeat procedures. Indwelling peritoneal drainage catheters can provide more durable symptom relief, avoiding the hazards and disadvantages of multiple repeat procedures. The goal of our study was to evaluate the technical success, complications and outcome associated with the use of these drainage catheters. We carried out a retrospective review of all patients who had indwelling catheters inserted for the management of symptomatic malignant ascites over a 4-year period. A total of 45 catheters were inserted in 38 patients. Insertion was technically successful in all patients, with immediate symptomatic relief. However, 2 cases of fatal hypotension were encountered in the first 24 h after catheter insertion (acute catheter-related mortality rate of 4.4%). These were attributed to rapid drainage of peritoneal fluid, although gastrointestinal tract bleeding was contributory in the second patient. Eight patients were lost to follow-up. Of the remaining 30, 13 (35.1%) patients developed catheter-related sepsis. The rate of infection was 1.6 episodes per 100 catheter-days. Thirteen tubes were removed prematurely, 6 (16.2%) due to sepsis, 5 (13.5%) because of tube blockage and 2 (5.4%) because of loculated ascites. The median length of time for which catheters were functional was 37 days (95% CI 14.1-59.6), with an average daily drainage of 539.5 ml (range 18-4000 ml). In conclusion, indwelling peritoneal drainage catheters provide a useful alternative to paracentesis in the management of symptomatic malignant ascites. Although it avoids the need for repeated paracentesis, it is not without risks. We discuss and propose some precautions to be observed in the use of these catheters.
腹腔穿刺术广泛应用于缓解有症状的恶性腹水。在一些患者中，腹水会迅速重新积聚，需要频繁重复进行该操作。留置腹腔引流管可提供更持久的症状缓解，避免多次重复操作的风险和弊端。我们研究的目的是评估使用这些引流管的技术成功率、并发症及结果。我们对4年内因有症状的恶性腹水而插入留置导管的所有患者进行了回顾性研究。38例患者共插入了45根导管。所有患者的导管插入在技术上均获成功，症状立即得到缓解。然而，在导管插入后的最初24小时内发生了2例致命性低血压（急性导管相关死亡率为4.4%）。这些归因于腹腔液的快速引流，尽管第二例患者存在胃肠道出血因素。8例患者失访。在其余30例患者中，13例（35.1%）发生了导管相关败血症。感染率为每100导管日1.6次发作。13根导管被提前拔除，6根（16.2%）因败血症，5根（13.5%）因导管堵塞，2根（5.4%）因局限性腹水。导管的中位使用时间为37天（95%CI 14.1 - 59.6），平均每日引流量为539.5毫升（范围18 - 4000毫升）。总之，在有症状的恶性腹水管理中，留置腹腔引流管是腹腔穿刺术的一种有用替代方法。虽然它避免了重复腹腔穿刺的需要，但并非没有风险。我们讨论并提出了在使用这些导管时应注意的一些预防措施。
