Christensen Lars, Wildgaard Lorna, Wildgaard Kim
Department of Anaesthesiology, Slagelse Hospital, Fælledvej 1, 4200, Slagelse, Denmark.
Royal School of Library and Information Science, Faculty of the Humanities, Copenhagen University, Birketinget 6, 2300, Copenhagen S, Denmark.
Support Care Cancer. 2016 Jun;24(6):2767-79. doi: 10.1007/s00520-016-3145-y. Epub 2016 Mar 1.
Management of refractory ascites traditionally includes medical treatment with diuretics or intermittent paracentesis. Patients with recurrent ascites may benefit from the use of permanent intra-abdominal catheters with more frequent drainage without hospitalization. The objective was to systematically asses the methodology of factors and endpoints reported in studies investigating permanent catheters for recurrent ascites treatment.
Using a systematic search strategy, we critically assessed the methodology when treating refractory ascites using a permanent catheter. Studies critically assessed included both retro- and prospective studies.
A total of 715 unique articles were found via PubMed, The Cochrane Library and Embase. Twenty-nine studies (tunnelled catheter = 12, peritoneal ports = 6 and peritoneovenous shunts = 11) with three distinct types of permanent catheters fulfilled the inclusion criteria. Only three studies reported technical success less than 100 %. Data on complications and treatment were not available in all papers; peritonitis (48 %), cellulitis (41 %), prophylactic antibiotics (48 %) and complications to catheter insertion were difficult to distinguish from advanced co-morbidity of patients. Thirteen studies (45 %) reported some type of evaluating patient experience or functional outcome, but only three studies used validated reproducible scales when assessing outcomes. Fifteen of the 29 studies included 30 patients or less.
Knowledge is limited because complications and outcomes are poorly defined. The expected increase in catheter treatment of refractory ascites necessitates comparative studies, using validated patient-related outcomes, and the reporting of unambiguous complications. A proposal of variables to include in future studies is presented.
难治性腹水的传统治疗方法包括使用利尿剂进行药物治疗或间歇性腹腔穿刺放液。复发性腹水患者可能受益于使用永久性腹腔导管，这种导管可更频繁地引流且无需住院。目的是系统评估在研究使用永久性导管治疗复发性腹水时所报告的因素和终点的方法。
采用系统检索策略，我们严格评估了使用永久性导管治疗难治性腹水时的方法。严格评估的研究包括回顾性研究和前瞻性研究。
通过PubMed、Cochrane图书馆和Embase共检索到715篇独特的文章。29项研究（隧道式导管 = 12项，腹腔端口 = 6项，腹膜静脉分流术 = 11项）使用三种不同类型的永久性导管符合纳入标准。只有三项研究报告技术成功率低于100%。并非所有论文都有关于并发症和治疗的数据；腹膜炎（48%）、蜂窝织炎（41%）、预防性抗生素（48%）以及导管插入的并发症与患者的晚期合并症难以区分。13项研究（45%）报告了某种评估患者体验或功能结局的类型，但只有三项研究在评估结局时使用了经过验证的可重复量表。29项研究中有15项纳入的患者为30例或更少。
由于并发症和结局定义不明确，相关知识有限。难治性腹水导管治疗预期的增加需要进行比较研究，使用经过验证的与患者相关的结局，并报告明确的并发症。本文提出了未来研究中应纳入的变量建议。
