Ultraschallgesteuerte Einlage von PleurX-Katheterdrainagen, Klinik, Verlauf und Komplikationsraten: eine retrospektive Studie bei n =93 Patienten mit therapierefraktärem Aszites

Over a period of 6 years, from May 2008 to August 2014, 99 tunneled PleurX-catheters were surgically introduced into the abdomen of 93 palliative care patients suffering from refractory ascites in the interdisciplinary ultrasound unit of the University Hospital in Marburg, Germany. The procedure was carried out under ultrasound guidance with a technical success rate of 100 %. One Patient developed hepatorenal failure postoperatively and had to be monitored overnight in the intensive care unit. No further surgery related complications occurred. On average the catheters remained in place for 40.26 days and in 79.6 % of the examined cases the catheters remained in place until the patient’s death. The average utilization of a catheter was 38.43 days. 23 patients experienced altogether 29 complications, 2 major complications (peritonitis, 2,2 %) and 27 minor complications. These complications consisted of blockage of the catheter (4,3 %), leakage of the drainage site, that had to be sutured (7,5 %), local infection of the tunnel tract (5,4 %) and dislocation of the catheter (11,8 %). Accidental dislocation of the catheter drain took place in 77,8 % of the cases within the first 15 days after placement of the PleurX-catheter. Six patients had a replacement of the catheter due to dislocation or infection. The average utilization of the second catheter was 80,7 days. No complications were described for these catheters. Age, gender, malignant ascites, type of patient care, ambulatory or in-patient catheter placement had no significant influence on the catheter function. Neither did ongoing chemotherapy or malignant ascites increase the risk of infection or blockage of the catheter, respectively. The findings of the Marburg study are comparable to the results of other international studies conducted in the last 15 years concerning surgery related complications, dwell time, utilization duration, risk of infection or leakage. Only in the case of catheter dislocation the patients from Marburg are at a higher risk compared to patients worldwide, which might be due to the lack of suture fixing of the catheter drain to the abdominal wall. In summary, the available data suggest that permanent, tunneled peritoneal catheters are a safe and effective alternative treatment to repeated large volume paracentesis in palliative patients with refractory ascites.