目的:恶性腹水(MA)在晚期癌症患者中很常见,约60%的MA患者出现痛苦症状。此外,MA已被确定为不良预后因素,因此,使硕士的管理成为一个重要的问题。我们旨在回顾描述MA的文献,提供相关研究的叙事综合。
方法:在PubMed上对1971年至2023年5月之间发表的文章进行了文献检索,和Cochrane图书馆使用单词“腹水/恶性腹水”和每个部分的主题。作者独立选择了所使用的文章并进行了总结。最后,本手稿通过所有作者的讨论获得共识.
■腹水形成的病理生理机制涉及血管通透性增加和通过淋巴系统的液体引流受损,这解释了腹膜癌的发生,肝肿瘤引起的门静脉高压症,肝细胞癌背景下的肝硬化,和肝静脉肿瘤阻塞引起的Budd-Chiari综合征。以前已经研究了各种治疗方法和程序的有效性和安全性;然而,目前尚无治疗指南.通常选择利尿剂和穿刺术作为治疗的第一线。腹膜内给药(catumaxomab,贝伐单抗,aflibercept,腹腔热化疗,曲安奈德),留置腹膜导管,腹膜静脉分流,无细胞和浓缩腹水回输疗法通常用于治疗难治性腹水。用于此目的的新设备是alfapump,将腹水从腹膜转移到膀胱。此外,胸段硬膜外镇痛可有效控制腹水相关症状.
结论:尽管有这些选择,目前尚未建立MA的标准治疗方法,因为这方面的试验很少.有很多问题需要调查,和未来的研究和治疗发展预期。
OBJECTIVE: Malignant ascites (MA) is common in patients with advanced cancer, and about 60% of patients with MA experience distressing symptoms. In addition, MA has been identified as a poor prognostic factor, therefore, making the management of MA an important issue. We aimed to review literature describing MA provide a narrative synthesis of relevant studies.
METHODS: A literature search of articles published between 1971 and May 2023 was performed in PubMed, and Cochrane library using the words \"ascites/malignant ascites\" and the theme of each section. Authors independently selected the articles used and summarized. Finally, this manuscript was obtained consensus through discussed among all authors.
UNASSIGNED: The pathophysiological mechanism of ascites formation involves increased vascular permeability and impaired fluid drainage through the lymphatic system, which explain the occurrence of peritoneal carcinomatosis, portal hypertension due to liver tumors, liver cirrhosis in the background of hepatocellular carcinoma, and Budd-Chiari syndrome caused by tumor occlusion of the hepatic vein. The efficacy and safety of various treatments and procedures have been investigated previously; however, no treatment guidelines have been established yet. Diuretics and
paracentesis are often selected as the first lines of treatment. Intraperitoneal drug administration (catumaxomab, bevacizumab, aflibercept, hyperthermic intraperitoneal chemotherapy, triamcinolone), indwelling peritoneal catheters, peritoneovenous shunting, and cell-free and concentrated ascites reinfusion therapy are commonly used to manage refractory ascites. A new device for this purpose is alfapump, which transfers ascites fluid from the peritoneum into the urinary bladder. In addition, thoracic epidural analgesia may be effective for managing ascites-related symptoms.
CONCLUSIONS: Despite these options, no standard treatment for MA has been established yet because few trials have been conducted in this area. There are many issues to be investigated, and future research and treatment development are expected.