Malignancy-related ascites에서 paracentesis 시행 중 알부민 주사

치료적 복수천자는 ovarian cancer로 인한 것이 아닌 peritoneal carcinomatosis의 주된 치료입니다.
Therapeutic paracentesis is the mainstay of treatment for peritoneal carcinomatosis that is not due to ovarian cancer. Case series suggest that approximately 90 percent of patients will respond symptomatically to paracentesis, with as little as a few liters of fluid removed. Large-volume abdominal paracentesis is usually needed every one to two weeks, although the frequency should be guided by the patient's symptoms (ie, distension, shortness of breath, and early satiety).

Portal hypertension으로 인한 복수 환자와 달리, malignancy-related ascites 환자들은 혈역학적 불안정에 대한 걱정 없이 ~21L까지 많은 복수를 제거할 수 있습니다. 혈역학적 악화를 예방하기 위한 LVP(large volume paracentesis) 이후 colloid replacement 필요성은 논란이 있습니다. Malignancy-related ascites 환자에서 특별히 복수 천자 시행과 관련하여 이행된 무작위 연구들은 없습니다. 그러나 임상 경험으로 볼 때 malignancy-related ascites 환자에서 IV 알부민 투약은 일반적으로 필요하지 않습니다. 
Unlike patients with ascites due to portal hypertension, patients with malignancy-related ascites can have large volumes of fluid (up to 21 liters) removed without fear of hemodynamic sequelae, including circulatory failure. The need for colloid replacement to prevent hemodynamic deterioration after large-volume paracentesis remains controversial. Randomized trials of albumin infusion have not been performed specifically in patients undergoing paracentesis for malignancy-related ascites. However, clinical experience suggests that intravenous albumin infusion is generally not necessary in patients with malignancy-related ascites. Furthermore, giving albumin increases the time that the patient spends undergoing paracentesis, especially if he or she has to go to an infusion center to receive the albumin. The use of albumin in patients undergoing large-volume paracentesis in the setting of portal hypertension is addressed elsewhere.

* Malignancy-related ascites may be seen with several tumors, including malignancies of the ovary, breast, colon, lung, pancreas, and liver.

REF. UpToDate 2017.12.29