Conventional treatment of malignant ascites

By | January 4, 2012

(A) of the conventional treatment of malignant ascites, diuretic therapy
Diuretic therapy is the most common means of ascites due to cirrhosis, but the general effect of malignant ascites is poor, its effectiveness may be associated with plasma renin / wake up solid from the same level, and plasma renin / waking solid remuneration of diuretics in patients with high may be effective, on the contrary, the possibility of a large void.
(B) of the peritoneal shunt
Peritoneal shunt for the first time in 1974 for the treatment of refractory ascites, and then gradually applied to the treatment of malignant ascites. Liquid ratio and placed paracentesis, PVS including the LeVeen or Denver shunt could not only alleviate symptoms, while avoiding a large number of repeated paracentesis induced protein loss, hypoproteinemia and increase with the plasma protein levels. Subretinal fluid with repeated paracentesis can not control the symptoms, consider the line PVS, but not associated with clotting mechanism for liver failure, infection recently or are, wrapped ascites, pseudomyxoma peritonei, and bloody ascites, ascites protein concentration> 45g / L in patients on peritoneal cytology positive or accompanied by a relative contraindication in patients with heart failure, the source of the gastrointestinal tract of patients, because the prognosis is poor, but also do not advocate application.
(C) of the conventional treatment of malignant ascites, peritoneal drainage tube
Peritoneal catheter for drainage of subretinal fluid paracentesis with severe electrolyte imbalance, or to be repeated paracentesis tapping the line contraindicated in patients with PVS. The law rarely cause electrolyte imbalance, non-cancer metastasis and the risk of clotting mechanism, and blocked drainage tube is not easy.
(D) abdominal paracentesis
Intra-abdominal pressure is increased in patients with malignant ascites symptoms occur such as nausea, vomiting, abdominal distension, abdominal pain, dyspnea, or orthopnea subretinal fluid paracentesis when possible, about 90% of patients receive temporary relief of symptoms, the average maintenance of 10.4 days. Because of its simple, quick relief of symptoms, is still basic clinical treatment, but many need to be repeated. The amount of ascites more non-encapsulated ascites, extensive adhesions, and no tumor mass in patients with large blind commonly used to wear, or in the ultrasound-guided puncture is safer.
(E) intraperitoneal chemotherapy
Intraperitoneal chemotherapy refers to chemotherapy drugs directly into the abdominal cavity of a treatment, can inhibit or kill cancer cells spread, the formation of solid tumors that have been, due to the impact of the surface of fibrous tissue, drug penetration is weak (only 1 – 3mm), the treatment less effective. Because the drug into the abdominal cavity hepatic metabolism of absorbed via the portal vein, less so into the systemic circulation, causing systemic toxicity is also small. Intraperitoneal chemotherapy has been widely used for perioperative or postoperative treatment, but also for the treatment of malignant ascites. Treatment of malignant ascites, ascites generally requires more than 2L, so that drugs can be an ideal distribution of ascites in patients with contraindications parcel used.
(F) the treatment of malignant abdominal ascites conventional radionuclide therapy
Intraperitoneal injection with a radioactive nuclide and effective treatment of malignant ascites was 41 %—– 54% of malignant ascites due to ovarian cancer 85%, ascites subsided after treatment, some patients for up to 6 months can be maintained The lower toxicity. 32P tissue penetration because of strong (8mm), and the long half-life (14 days), was used more than clinical dose of 20mCi.

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