背景:胸部手术后的乳糜胸是一种严重的并发症,发病率和死亡率高,为0.10(95%置信区间[CI]0.06-0.02)。对于非手术治疗或早期再手术是否应作为初始干预措施,尚无共识。本系统综述和荟萃分析旨在评估保守方法治疗心胸手术后乳糜漏的效果。
方法:在PubMed®中进行了系统评价,Embase,科克伦图书馆中心,和LILACS(BibliotecaVirtualemSaúde)数据库;还进行了参考文献的手动搜索。纳入标准为心胸手术患者,接受任何非手术治疗的患者(例如,全胃肠外营养,低脂饮食,中链甘油三酯),和评估乳糜胸分辨率的研究,住院时间,术后并发症,感染,发病率,和死亡率。
■心胸手术后乳糜胸的非手术治疗具有显著的住院时间,发病率,死亡率,和再操作率。
结果:选择了22篇文章。肺部并发症,感染,心律失常是手术后最常见的并发症。心胸手术中乳糜胸的发生率为1.8%(95%CI1.7-2%)。维持胸管的平均时间为16.08天(95%CI12.54-19.63),接受非手术治疗的乳糜胸患者的住院时间为23.74天(95%CI16.08-31.42)。在接受保守治疗的患者中,发病率事件为0.40(95%CI0.23-0.59),再次手术率为0.37(95%CI0.27~0.49)。死亡率为0.10(95%CI0.06-0.02)。
结论:心胸手术后乳糜胸的非手术治疗具有显著的住院时间,发病率,死亡率,和再操作率。
Chylothorax after thoracic surgery is a severe complication with high morbidity and mortality rate of 0.10 (95% confidence interval [CI] 0.06 - 0.02). There is no agreement on whether nonoperative treatment or early reoperation should be the initial intervention. This systematic
review and meta-analysis aimed to evaluate the outcomes of the conservative approach to treat chyle leakage after cardiothoracic surgeries.
A systematic
review was conducted in PubMed®, Embase, Cochrane Library Central, and LILACS (Biblioteca Virtual em Saúde) databases; a manual search of references was also done. The inclusion criteria were patients who underwent cardiothoracic surgery, patients who received any nonoperative treatment (e.g., total parenteral nutrition, low-fat diet, medium chain triglycerides), and studies that evaluated chylothorax resolution, length of hospital stay, postoperative complications, infection, morbidity, and mortality.
Nonoperative treatment for chylothorax after cardiothoracic procedures has significant hospital stay, morbidity, mortality, and reoperation rates.
Twenty-two articles were selected. Pulmonary complications, infections, and arrhythmia were the most common complications after surgical procedures. The incidence of chylothorax in cardiothoracic surgery was 1.8% (95% CI 1.7 - 2%). The mean time of maintenance of the chest tube was 16.08 days (95% CI 12.54 - 19.63), and the length of hospital stay was 23.74 days (95% CI 16.08 - 31.42) in patients with chylothorax receiving nonoperative treatment. Among patients that received conservative treatment, the morbidity event was 0.40 (95% CI 0.23 - 0.59), and reoperation rate was 0.37 (95% CI 0.27 - 0.49). Mortality rate was 0.10 (95% CI 0.06 - 0.02).
Nonoperative treatment for chylothorax after cardiothoracic procedures has significant hospital stay, morbidity, mortality, and reoperation rates.