Ratre Brajesh Kumar, Suvvari Praneeth, Hoda Wasimul, Roychoudhury Priodarshi, Bharti Sachidanand Jee, Bhatnagar Sushma
Department of Oncoanaesthesia and Palliative Medicine, Dr. B.R. Ambedkar IRCH, AIIMS, New Delhi, India.
Indian J Palliat Care. 2019 Jan-Mar;25(1):57-60. doi: 10.4103/IJPC.IJPC_145_18.
Malignant ascites is an accumulation of fluid in the peritoneal cavity due to the manifestation of terminal metastatic malignancies. Accumulation of ascitic fluid could cause abdominal distention, early satiety, and shortness of breath. The onset and progression of these symptoms are not only distressing but also cause deterioration of the quality of life. Malignant ascites is associated with poor prognosis with anticipated life expectancy ranging from 1 to 4 months. Therapeutic paracentesis is the mainstay of palliation for malignant ascites. It only provides a temporary relief of symptoms, ascites re-accumulates, and paracentesis has to be repeated.
The aim of this case series was to evaluate our experiences when treating malignant ascites with placement of central venous catheter in the peritoneal cavity, with special emphasis on patient satisfaction, comfort of caregiver, technical success, and adverse events.
Five patients with advanced disease and recurrent malignant ascites who required multiple paracentesis were selected for placement of 7-FG triple-port Central venous catheter in the peritoneal cavity. Maximum fluids that can be tapped were removed in ward. Patients and their relatives were assessed for satisfaction with the procedure.
Out of 5 patients, 3 were female and 2 male (age between 46 and 62 years). Two patients had carcinoma gallbladder and one each of carcinoma ovary, breast, and prostate. All patients were followed up till 1 month from catheter placement. Patients and their relatives were well satisfied in terms of frequent hospital visit for paracentesis.
In summary, we suggest that central venous catheter may be used as indwelling peritoneal catheter for the symptom management of recurrent malignant ascites. It provides a relatively safe and cost-effective alternative to serial large-volume paracentesis that requires multiple hospital admissions.
恶性腹水是终末期转移性恶性肿瘤表现导致的腹腔内液体蓄积。腹水蓄积可引起腹胀、早饱及呼吸急促。这些症状的出现和进展不仅令人痛苦，还会导致生活质量下降。恶性腹水预后较差，预期寿命为1至4个月。治疗性腹腔穿刺术是缓解恶性腹水的主要方法。它只能暂时缓解症状，腹水会再次蓄积，不得不重复进行腹腔穿刺术。
本病例系列的目的是评估我们在通过在腹腔内放置中心静脉导管治疗恶性腹水时的经验，特别强调患者满意度、护理人员的舒适度、技术成功率及不良事件。
选择5例晚期疾病且反复出现恶性腹水、需要多次腹腔穿刺术的患者，在其腹腔内放置7-FG三腔中心静脉导管。在病房内尽可能多地抽出腹水。评估患者及其亲属对该操作的满意度。
5例患者中，3例为女性，2例为男性（年龄在46至62岁之间）。2例患有胆囊癌，1例患有卵巢癌、乳腺癌和前列腺癌各1例。所有患者均从导管置入后随访至1个月。患者及其亲属对无需频繁住院进行腹腔穿刺术非常满意。
总之，我们建议中心静脉导管可作为留置腹腔导管用于复发性恶性腹水的症状管理。它为需要多次住院的系列大容量腹腔穿刺术提供了一种相对安全且经济有效的替代方法。
