Adderley U, Smith R
North Yorkshire and York Primary Care Trust, Community Nurses, Malton Hospital, Middlecave Road, Malton, North Yorkshire, UK YO17 7NG.
Cochrane Database Syst Rev. 2007 Apr 18(2):CD003948. doi: 10.1002/14651858.CD003948.pub2.
Fungating wounds arise from primary, secondary or recurrent malignant disease and are associated with advanced cancer. A small proportion of patients may achieve healing following surgical excision but treatment is usually palliative. Fungating wound management usually aims to slow disease progression and optimise quality of life by alleviating physical symptoms, such as copious exudate, malodour, pain and the risk of haemorrhage, through appropriate dressing and topical agent selection.
To conduct a systematic review of the evidence of the effects of dressings and topical agents on quality of life and symptoms that impact on quality of life in people with fungating malignant wounds.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) and the Wounds Group Specialised Register in August 2006. The Cochrane Breast Cancer Group and the Pain and Palliative Care Group were contacted for relevant studies. The Allied and Complementary Medicine (AMED) database was searched in January 2007. There was no restriction on language or date of publication.
Randomised controlled trials (RCTs) or, in their absence, controlled clinical trials (CCTs) with a concurrent control group, both published and unpublished, and written in any language, were eligible for inclusion.
Data extraction was undertaken by one author and checked for accuracy by a second author. Two review authors independently assessed trial quality.
Two trials involving 63 people were included. One RCT in women with superficial breast lesions compared 6% miltefosine solution with placebo and found that miltefosine delayed tumour progression. However, this trial had methodological limitations. A second trial compared topical metronidazole with placebo and found that metronidazole reduced malodour. However, this trial also had methodological limitations and was underpowered.
AUTHORS' CONCLUSIONS: There is weak evidence from one small trial that 6% miltefosine solution applied topically to people with superficial fungating breast lesions (smaller than 1cm) who have received either previous radiotherapy, surgery, hormonal therapy or chemotherapy for their breast cancer may slow disease progression. There is insufficient evidence in this review to give a clear direction for practice with regard to improving quality of life or managing wound symptoms associated with fungating wounds. More research is needed.
溃疡性伤口源于原发性、继发性或复发性恶性疾病，与晚期癌症相关。一小部分患者在手术切除后可能实现伤口愈合，但治疗通常是姑息性的。溃疡性伤口管理通常旨在通过选择合适的敷料和外用药物，减轻大量渗液、恶臭、疼痛和出血风险等身体症状，从而减缓疾病进展并优化生活质量。
对敷料和外用药物对溃疡性恶性伤口患者生活质量及影响生活质量的症状的作用证据进行系统评价。
2006年8月，我们检索了Cochrane对照试验中心注册库（CENTRAL）和伤口组专业注册库。我们联系了Cochrane乳腺癌组和疼痛与姑息治疗组以获取相关研究。2007年1月检索了联合与补充医学（AMED）数据库。对语言和出版日期没有限制。
随机对照试验（RCT），或者在没有RCT的情况下，有同期对照组的对照临床试验（CCT），无论已发表还是未发表，且语言不限，均符合纳入标准。
由一位作者进行数据提取，并由另一位作者检查准确性。两位综述作者独立评估试验质量。
纳入了两项涉及63人的试验。一项针对患有浅表性乳腺病变女性的RCT将6%米替福新溶液与安慰剂进行比较，发现米替福新可延缓肿瘤进展。然而，该试验存在方法学局限性。另一项试验将外用甲硝唑与安慰剂进行比较，发现甲硝唑可减轻恶臭。然而，该试验也存在方法学局限性且效能不足。
一项小型试验提供的证据薄弱，对于既往接受过乳腺癌放疗、手术、激素治疗或化疗的浅表性溃疡性乳腺病变（小于1cm）患者，局部应用6%米替福新溶液可能减缓疾病进展。本综述中没有足够的证据为改善生活质量或处理与溃疡性伤口相关的伤口症状的实践提供明确指导。需要更多的研究。
