Keen Alison, Fitzgerald Debbie, Bryant Andrew, Dickinson Heather O
Cancer Care, Southampton General Hospital, Tremona Road, Southampton, UK, SO16 6YD.
Cochrane Database Syst Rev. 2010 Jan 20(1):CD007794. doi: 10.1002/14651858.CD007794.pub2.
Most patients with advanced ovarian cancer and some patients with advanced endometrial cancer need repeated drainage for malignant ascites. Guidelines to advise those involved in the drainage of ascites are usually produced locally and are generally not evidence-based but mainly based on clinicians' anecdotal evidence and experience. To discover whether there are ways of managing drains that have been demonstrated to improve the efficacy and quality of the procedure is key in making recommendations which could improve the quality of life (QOL) for women at this critical period of their lives.
To evaluate the benefit and harms of different practices in the management of drains for malignant ascites in the care of women with advanced or recurrent gynaecological cancer. The review aimed to evaluate the evidence regarding the following questions; How long should the drain stay in place? Should the volume of fluid drained be replaced intravenously? Should the drain be clamped to regulate the drainage of fluid? Should any particular vital observations be regularly recorded?
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) Issue 1, 2009, Cochrane Gynaecological Cancer Group Trials Register, MEDLINE1950 to February Week 3 2009, Embase 1980 to 2009 Week 8 2009. We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of review articles and contacted experts in the field.
We searched for randomised controlled trials (RCTs), quasi-RCTs and non-randomised studies that compared a range of interventions for management of multiple paracentesis in women with malignant ascites who had a confirmed histological diagnosis of gynaecological cancer.
Two review authors independently assessed whether potentially relevant studies met the inclusion criteria. No trials were found and therefore no data were analysed.
The search strategy identified 1664 unique references of which 1646 were excluded on the basis of title and abstract. The remaining 18 articles were retrieved in full, but none satisfied the inclusion criteria.
AUTHORS' CONCLUSIONS: Since no relevant studies were identified, we are unable to make recommendations regarding the management of drains for malignant ascites in women with gynaecological cancer. Large, multi-centre RCTs are required to evaluate the efficacy and safety of the management of ascitic drains when in situ and their impact on QOL.
大多数晚期卵巢癌患者以及部分晚期子宫内膜癌患者需要反复引流恶性腹水。指导腹水引流相关人员的指南通常是当地制定的，一般并非基于循证医学，而是主要基于临床医生的经验证据和轶事。在这一关键时期，找出已被证实可提高操作效果和质量的引流管理方法，对于改善女性生活质量（QOL）至关重要。
评估在晚期或复发性妇科癌症女性患者护理中，不同恶性腹水引流管理方法的益处和危害。该综述旨在评估有关以下问题的证据：引流管应留置多长时间？引流的液体量是否应通过静脉补液补充？引流管是否应夹闭以调节液体引流？是否应定期记录特定的重要观察指标？
我们检索了Cochrane对照试验中心注册库（CENTRAL）2009年第1期、Cochrane妇科癌症小组试验注册库、MEDLINE 1950年至2009年2月第3周、Embase 1980年至2009年第8周2009年的数据。我们还检索了临床试验注册库、科学会议摘要、综述文章的参考文献列表，并联系了该领域的专家。
我们检索了随机对照试验（RCT）、半随机对照试验和非随机研究，这些研究比较了一系列针对经组织学确诊为妇科癌症且伴有恶性腹水的女性进行多次腹腔穿刺引流管理的干预措施。
两位综述作者独立评估潜在相关研究是否符合纳入标准。未找到相关试验，因此未进行数据分析。
检索策略共识别出1664条独特参考文献，其中1646条基于标题和摘要被排除。其余18篇文章全文获取，但均不符合纳入标准。
由于未识别出相关研究，我们无法就妇科癌症女性患者恶性腹水引流管理提出建议。需要开展大型多中心随机对照试验，以评估腹水引流管在位时的管理效果和安全性及其对生活质量的影响。
