Stukan Maciej
Department of Gynecologic Oncology, Gdynia Oncology Center, Szpitale Wojewodzkie w Gdyni Sp. z o.o., Gdynia, Poland.
Cancer Manag Res. 2017 Apr 12;9:115-130. doi: 10.2147/CMAR.S100210. eCollection 2017.
Malignant ascites (MA) is a sign of advanced cancer and poor prognosis. MA can result in impairment in quality of life (QOL) and significant symptoms. As a supportive treatment, ascites can be drained by paracentesis (PC), percutaneously implanted catheters (tunneled, untunneled, central venous catheters), or peritoneal ports, or peritoneovenous shunts. The aim of this study was to evaluate the effectiveness, safety, and patient-reported outcomes (PRO) of different drainage methods for the management of MA. A systematic review of the literature was performed, and 32 original articles met the inclusion criteria. Patients selected for permanent drain insertion demonstrated symptoms related to MA and had undergone repeated PC. The primary focus of the reviewed articles was procedural safety issues. The rate of technical success of drainage device installation was 100%. Most patients experienced improvements in symptom control after ascites drainage. When analyzed together, 19.7% (255/1297) of patients experienced any complication and 6.2% (81/1297) experienced serious adverse events during MA drainage. Complications were reported for every drainage method; however, the least occurred after PC or central venous catheter, while the most serious occurred after peritoneovenous shunts. Adverse events were as follows: catheter obstruction: 4.4%, infection: 4.1%, leakage: 3.5%, catheter dislodgment: 2.3%, hypotension: 0.6%, injuries during device insertion: 0.6%, renal impairment: 0.5%, electrolyte imbalance: 0.2%, other: 3.6%. PRO and QOL endpoints were available for 12 studies. When PRO were measured using an interview, a significant improvement in symptom control and QOL was reported in almost all patients. Once standardized questionnaires were used, improvements in symptomatic scores and role functioning were observed. Deterioration was observed in cognitive and emotional subscales. MA drainage is a safe and effective method to control symptoms associated with ascites, and should be perceived as a supportive care, that can be applied for those who need it at any time of their cancer trajectory. Patient selection should be performed using a thorough assessment of symptoms and QOL, and should not be delayed.
恶性腹水（MA）是癌症晚期的征象，预后较差。MA可导致生活质量（QOL）受损和出现显著症状。作为一种支持性治疗，腹水可通过腹腔穿刺术（PC）、经皮植入导管（隧道式、非隧道式、中心静脉导管）、腹膜置管或腹膜静脉分流术进行引流。本研究的目的是评估不同引流方法治疗MA的有效性、安全性及患者报告结局（PRO）。我们对文献进行了系统回顾，32篇原创文章符合纳入标准。被选进行永久性引流管置入的患者表现出与MA相关的症状，且已接受过多次PC。综述文章的主要关注点是操作安全性问题。引流装置安装的技术成功率为100%。大多数患者在腹水引流后症状控制得到改善。综合分析时，19.7%（255/1297）的患者在MA引流期间出现任何并发症，6.2%（81/1297）的患者出现严重不良事件。每种引流方法均有并发症报告；然而，PC或中心静脉导管后并发症最少，而腹膜静脉分流术后并发症最严重。不良事件如下：导管阻塞：4.4%，感染：4.1%，渗漏：3.5%，导管移位：2.3%，低血压：0.6%，装置置入期间损伤：0.6%，肾功能损害：0.5%，电解质失衡：0.2%，其他：3.6%。有12项研究提供了PRO和QOL终点数据。当通过访谈测量PRO时，几乎所有患者均报告症状控制和QOL有显著改善。一旦使用标准化问卷，症状评分和角色功能均有改善。认知和情感子量表出现恶化。MA引流是控制与腹水相关症状的一种安全有效的方法，应被视为一种支持性护理，可在癌症病程的任何时候应用于有需要的患者。应通过对症状和QOL的全面评估来进行患者选择，且不应延迟。
