Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710, USA.
J Vasc Interv Radiol. 2013 Sep;24(9):1303-8. doi: 10.1016/j.jvir.2013.05.042. Epub 2013 Jul 19.
To assess the success and safety of tunneled peritoneal drainage catheters for the management of ascites refractory to medical management.
A total of 188 consecutive patients (83 male, 105 female; average age 59 y) with refractory ascites were treated with tunneled peritoneal drainage catheters from January 1, 2006, to August 10, 2012. A combination of fluoroscopic and ultrasound guidance was used to insert all catheters. Patient history, procedural records, and clinical follow-up documents were retrospectively reviewed. Clinical data (malignancy, renal disease, chemotherapy, neutropenia, albumin levels) were compared with respect to patency and complication rates with the use of odds ratios. Catheter survival curves were generated with the Kaplan-Meier method and life-table analysis for the cumulative and infection-free survival of primary and secondary catheters.
A total of 193 catheter placements or interventions were performed in 188 patients with refractory ascites: 170 catheters (93%) were placed for malignant etiologies and 13 (7%) for nonmalignant etiologies. The most common malignancies were ovarian (22%), pancreatic (12%), and breast (11%). The most common nonmalignant etiologies were end-stage liver disease (n = 7) and heart failure (n = 6). There was a 100% technical success rate for catheter insertion; no procedure-related deaths or major placement complications were identified. Catheter survival ranged from 0 to 796 days (mean, 60 d), with a total of 11,936 cumulative catheter-days. Fourteen postplacement complications were identified: five patients experienced catheter malfunction, four had leakage of ascites at the incisional site requiring suture placement, three had cellulitis of the tunnel tract, and two developed peritonitis. The annual complication event rate was 0.43 events per year (ie, 0.12 events per 100 catheter-days). Pancreatic malignancy was associated with a significantly increased rate of catheter malfunction (ie, occlusion).
Radiologic insertion of tunneled peritoneal drainage catheters demonstrated a 100% technical success rate for insertion and an acceptable complication rate for the management of refractory ascites.
评估经皮隧道式腹膜引流导管在治疗对药物治疗无效的腹水方面的成功率和安全性。
2006 年 1 月 1 日至 2012 年 8 月 10 日期间，共对 188 例对药物治疗无效的腹水患者（83 例男性，105 例女性；平均年龄 59 岁）进行了经皮隧道式腹膜引流导管治疗。所有导管均采用透视和超声引导联合插入。回顾性查阅患者病史、操作记录和临床随访文件。采用比值比比较临床数据（恶性肿瘤、肾脏疾病、化疗、中性粒细胞减少症、白蛋白水平）与通畅率和并发症发生率的关系。采用 Kaplan-Meier 方法和寿命表分析生成主要和次要导管的累积和无感染生存曲线。
188 例对药物治疗无效的腹水患者共进行了 193 次导管放置或介入操作：170 例（93%）导管放置用于恶性肿瘤，13 例（7%）用于非恶性肿瘤。最常见的恶性肿瘤是卵巢癌（22%）、胰腺癌（12%）和乳腺癌（11%）。最常见的非恶性肿瘤病因是终末期肝病（n=7）和心力衰竭（n=6）。导管插入的技术成功率为 100%；未发现与操作相关的死亡或主要放置并发症。导管的生存时间从 0 到 796 天不等（平均 60 天），总共有 11936 个累积导管天数。发现 14 个置管后并发症：5 例患者出现导管功能障碍，4 例切口处腹水漏出需要缝合固定，3 例隧道部位蜂窝织炎，2 例发生腹膜炎。每年并发症发生率为 0.43 次/年（即 0.12 次/100 导管日）。胰腺恶性肿瘤与导管功能障碍（即闭塞）的发生率显著增加相关。
放射介入经皮隧道式腹膜引流导管在治疗对药物治疗无效的腹水方面具有 100%的技术成功率和可接受的并发症发生率。
