Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, UK.
Department of Gastroenterology and Hepatology, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
Liver Int. 2019 Sep;39(9):1594-1607. doi: 10.1111/liv.14162. Epub 2019 Jul 17.
BACKGROUND & AIMS: The incidence and mortality from end-stage liver disease is increasing, with a minority eligible for liver transplantation. Ascites is the commonest complication of end-stage liver disease and large volume paracentesis (LVP) the accepted management strategy where refractory to medical treatment. In malignant ascites, permanent indwelling peritoneal catheters (PIPC) are an established palliative intervention. The aims are to describe available data using permanent indwelling peritoneal catheters in refractory ascites due to end-stage liver disease.
Using systematic review methodology, databases were searched (MEDLINE, EMBASE, CINAHL [The Cumulative Index to Nursing and Allied Health Literature], Google Scholar and Cochrane Database of Systematic Reviews from inception-March 2018), for studies combining ascites and palliative care. Inclusion and exclusion criteria were applied to results.
Following initial and updated searches, 225 studies were identified for full text review, 18 were eligible for final analysis. The studies displayed heterogeneity in design, reported on different indwelling catheters and were overall of low quality. Only one pilot randomised controlled trial was identified, of PIPC versus LVP, recruiting one patient into each arm. Technical insertion success was 100%, with low rates of non-infectious complications (<12%), none life threatening. Rates of bacterial peritonitis were not unacceptably high (12.7%), considering this was an end-stage liver disease population and only a minority utilising long-term prophylactic antibiotics. Only one study attempted quality-of-life assessments; none addressed potential health economic benefits.
Despite lack of well-designed studies, preliminary data suggests low significant complication rates; however safety and efficacy of permanent indwelling peritoneal catheters in end-stage liver disease remains to be confirmed. Further prospective randomised controlled trials are warranted, potentially translating permanent indwelling peritoneal catheters into improved palliative care in end-stage liver disease.
终末期肝病的发病率和死亡率正在增加，只有少数患者有资格进行肝移植。腹水是终末期肝病最常见的并发症，大量腹腔穿刺术（LVP）是治疗难治性腹水的公认方法。在恶性腹水中，永久性留置腹腔导管（PIPC）是一种已确立的姑息性干预措施。本研究旨在描述终末期肝病难治性腹水使用永久性留置腹腔导管的现有数据。
采用系统评价方法，检索数据库（MEDLINE、EMBASE、CINAHL[护理与联合健康文献累积索引]、Google Scholar 和 Cochrane 系统评价数据库，从成立到 2018 年 3 月），检索关于腹水和姑息治疗的研究。对结果进行纳入和排除标准。
经过初步和更新的搜索，共确定了 225 项研究进行全文审查，其中 18 项符合最终分析标准。这些研究在设计、报告的留置导管以及总体质量方面存在异质性。仅确定了一项针对 PIPC 与 LVP 的小型随机对照试验，每组各纳入一名患者。技术插入成功率为 100%，非感染性并发症发生率低（<12%），无危及生命的并发症。细菌性腹膜炎的发生率并不高（12.7%），考虑到这是一个终末期肝病患者群体，只有少数患者使用长期预防性抗生素。只有一项研究尝试进行生活质量评估；没有研究探讨潜在的健康经济效益。
尽管缺乏精心设计的研究，但初步数据表明低显著并发症发生率；然而，永久性留置腹腔导管在终末期肝病中的安全性和疗效仍有待证实。需要进一步进行前瞻性随机对照试验，可能会将永久性留置腹腔导管转化为终末期肝病的改善姑息治疗。
