背景:神经母细胞性肿瘤手术切除后的乳糜漏/腹水可能会延迟化疗的开始并恶化预后。先前的研究报道了一个高度可变的发病率和风险因素仍然很大程度上未知。本研究旨在分析乳糜漏和腹水的真实发生率,并试图确定风险因素和最佳治疗策略。
方法:根据PRISMA指南搜索Medline/Embase数据库。文献综述,病例报告,非英语论文被排除在外。数据是由2位作者选择论文后独立提取的。
结果:最终分析得出15项研究,其中N=1468名患者。术后记录乳糜腹水171例(12%)。大多数经历乳糜漏的患者都成功地通过引流进行了保守治疗,肠道休息,肠外营养和奥曲肽以及这些治疗方案的可变组合。7/171(4%)患者需要手术探查以控制麻烦的持续性乳糜漏。在风险因素分析中,较高的肿瘤分期与乳糜漏的风险显著相关(P<0.0001),而与肾上腺和非肾上腺肿瘤位置无相关性,INRG风险组和肿瘤侧向性。
结论:神经母细胞性肿瘤手术后的乳糜渗漏是一种常见的病态并发症,发生在约12%的患者中。较高的INSS肿瘤分期预示着较大的风险。保守治疗策略在大多数情况下似乎是成功的。为了避免这种并发症,特别是对于那些需要广泛的根治性手术包括腹膜后淋巴结切除术的较高肿瘤分期的患者,建议进行细致的肠系膜淋巴结扎术。
方法:III.
方法:系统评价。
BACKGROUND: Chyle leakage/ascites after surgical resection of neuroblastic tumors may delay the start of chemotherapy and worsen prognosis. Previous studies have reported a highly variable incidence and risk factors remain largely unknown. This study aims to analyze the true incidence of chyle leaks and ascites and seeks to identify risk factors and optimal treatment strategies.
METHODS: Medline/Embase databases were searched according to PRISMA guidelines. Literature reviews, case reports, and non-English papers were excluded. Data were extracted independently following paper selection by 2 authors.
RESULTS: The final analysis yielded 15 studies with N = 1468 patients. Chylous ascites was recorded postoperatively in 171 patients (12%). Most patients experiencing chyle leaks were successfully treated conservatively with drainage, bowel rest, parenteral nutrition and octreotide with variable combinations of these treatment options. 7/171 (4%) patients required operative exploration to control troublesome persistent chyle leaks. In risk factor analysis, higher tumor stage was significantly associated with the risk of chyle leak (P < 0.0001) whereas no correlation was observed with adrenal vs non-adrenal tumor location, INRG risk groups and tumor laterality.
CONCLUSIONS: Chyle leakage after surgery for neuroblastic tumors is a common morbid complication occurring in some 12% of patients. Higher INSS tumor stage portends greater risk(s). Conservative therapy strategies appear successful in the majority of cases. To avert this complication meticulous mesenteric lymphatic ligation is recommended especially for those patients with higher tumor stage(s) requiring extensive radical surgery including retroperitoneal lymph node resection.
METHODS: III.
METHODS: Systematic
review.