Journal of Hospice and Palliative Care

Korean Society for Hospice and Palliative Care (한국호스피스완화의료학회)
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Analysis of Effect and Prognostic Factors Associated with Catheter Intervention on Ascites in Terminal Cancer Patient

복수가 있는 말기 암환자에서 복수 배액관 시술의 효과와 예후요인 분석

  • Jang, Mungsun (Department of Family Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kim, Chul-Min (Department of Family Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Yoon, Johi (Department of Palliative Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Nah, Jung-Ran (Department of Palliative Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Chang, Seung-Nam (Department of Palliative Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kim, Myung Ok (Department of Palliative Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Lee, Ja Young (Department of Family Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • 장명선 (가톨릭대학교 서울성모병원 가정의학과) ;
  • 김철민 (가톨릭대학교 서울성모병원 가정의학과) ;
  • 윤조히 (가톨릭대학교 서울성모병원 완화의학과) ;
  • 라정란 (가톨릭대학교 서울성모병원 완화의학과) ;
  • 장승남 (가톨릭대학교 서울성모병원 완화의학과) ;
  • 김명옥 (가톨릭대학교 서울성모병원 완화의학과) ;
  • 이자영 (가톨릭대학교 서울성모병원 가정의학과)
  • Received : 2016.05.03
  • Accepted : 2016.11.26
  • Published : 2016.12.01
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Abstract

Purpose: Malignant ascites is a common complication in terminal cancer patients. Less-invasive pigtail catheter insertion is the most frequent procedure in patients who need repeated ascites drainage. This study investigated effects and adverse events associated with catheter insertion for ascites drainage and evaluated prognostic outcomes. Methods: We reviewed medical records between 2010 and 2013 of hospice and palliative care institutions in Seoul, South Korea. Among 2,608 inpatients, 67 patients received ascites pigtail catheter drainage. We reviewed demographic data, palliative performance scale, laboratory data, duration of catheter insertion, prevalence and type of complications, use and duration of antibiotics, and survival time. Univariate and multivariate Cox regression models were used to evaluate prognostic outcomes related with catheter insertion. Results: Ascites drainage was performed most commonly in hepatobiliary and gastric cancer patients. Ascites symptoms improved in 55 patients after the catheter drainage. Adverse events included pain (19.4%), leakage (14.9%), disconnection (7.5%), catheter occlusion (6%) and fever (4.5%). In Cox regression analysis, survival time from the catheter insertion was significantly associated with Palliative Performance Scale (PPS) (HR 0.73; P value 0.045) and serum sodium level (HR 2.77; P value 0.003) in a multivariate model. Conclusion: Patients' PPS and serum sodium level should be considered before making a decision of pigtail catheter insertion.

목적: 말기 암환자에서 악성 복수는 흔하게 발생하며, 그 자체가 나쁜 예후를 시사한다. 악성 복수에 대한 효과적이고, 최소한의 침습적인 방법으로 복수배액관 삽입이 제안되었다. 본 연구는 복수배액관 삽입을 시행한 말기 암환자들을 대상으로 복수배액관 시술의 효과와 부작용에 대하여 분석하고 시술 후 예후에 영향을 미치는 요인을 알아보기 위하여 시행되었다. 방법: 서울 소재 일개 3차 의료기관 호스피스 병동에 2010년 1월 1일부터 2013년 12월 31일까지 입원한 말기 암환자 2,608명 중 복수배액관 삽입을 시행한 67명의 환자들의 의무기록을 조사하였다. 인구학적 정보, 완화의료 수행지수, 혈액검사, 복수 배액관 유지 기간, 시술 합병증의 종류와 빈도, 항생제 사용 여부와 기간, 시술 후 생존기간을 분석하였다. 복수 배액관 삽입 후 생존기간에 영향을 미치는 요인을 평가하기 위해 단변량 및 다변량 콕스 비례위험 회귀분석을 실시하였다. 결과: 총 67명의 연구대상자 중 원발암은 간암 및 담도암과 위암이 가장 흔하였다. 복수배액관 시술 후 복수관련 증상의 호전은 55명(82.1%)에서 있었다. 시술 후 합병증은 통증(19.4%), 누수(14.9%), 배액관 빠짐(7.5%), 배액관 막힘(6%), 발열(4.5%)이었다. 복수배액관 시술 후 생존기간에 영향을 주는 인자는 다변량 콕스 비례위험 회귀분석 결과 완화의료 수행지수(HR 0.73; P=0.045), 저나트륨혈증(HR 2.77; P=0.003)이었다. 결론: 복수를 동반한 말기 암환자에서 복수 배액관 시술 시, 완화의료 수행지수와 저나트륨혈증은 예후 인자로 사용될 수 있을 것이다. 추후 대규모의 전향적 연구가 요구된다.

Keywords

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