Kirmani Bilal, Kirmani Basitt, Sogliani Franco
Department of Cardiothoracic Surgery, Lancashire Cardiac Centre, Blackpool Victoria Hospital, Whinney Heys Road, Blackpool FY3 8NR, Blackpool, UK.
Interact Cardiovasc Thorac Surg. 2010 Nov;11(5):649-59. doi: 10.1510/icvts.2010.233114. Epub 2010 Aug 13.
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether asymptomatic bronchogenic cysts in adults require surgery or whether they can be adequately managed with conservative treatment or observation only. Altogether more than 310 papers were found using the reported search of which 23 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. The papers identified included 683 adult patients with bronchogenic cysts. There was a substantial variation between the papers in the proportion of patients presenting with symptoms (6-79%), and all patients with symptoms were managed surgically. The majority of asymptomatic patients underwent empirical surgery to prevent the development of symptoms, to confirm the diagnosis and to rule out malignant transformation. A total of 74 asymptomatic patients were treated conservatively or had definitive diagnosis or treatment delayed. The longest period of observation was 22 years. In total, 33 (45%) of asymptomatic patients eventually developed symptoms requiring surgery. There was no evidence to suggest that surgery following a cyst-related complication increased the postoperative morbidity or mortality, although it was noted to increase the technical difficulty of the procedure. There were no descriptions of misdiagnosis of malignancy as bronchogenic cyst, but 5 (0.7%) of the 683 cysts studied were found to be associated with malignant cells in the cyst wall. The figures cited, however, represent only symptomatic or incidental presentations. As the prevalence of these otherwise benign entities is not known, the rates of progression to symptoms and associated malignancy may be lower than those described. We would advocate informing asymptomatic patients diagnosed with bronchogenic cyst of the 20% morbidity of surgery whether immediate or delayed, the 45% risk of developing symptoms, some of which may be serious, and the 0.7% risk of malignancy. Should patients opt for conservative management, this can be offered only if close long-term follow-up can be guaranteed.
一篇心脏外科的最佳证据主题文章是按照结构化方案撰写的。所探讨的问题是，成人无症状支气管源性囊肿是否需要手术，或者是否仅通过保守治疗或观察就能得到充分处理。通过报告的检索方式总共找到310多篇论文，其中23篇代表了回答该临床问题的最佳证据。这些论文的作者、期刊、出版日期和国家、研究的患者群体、研究类型、相关结局和结果都被制成了表格。所确定的论文包括683例患有支气管源性囊肿的成年患者。各论文中出现症状的患者比例差异很大（6% - 79%），所有有症状的患者均接受了手术治疗。大多数无症状患者接受了经验性手术，以预防症状出现、确诊并排除恶变。共有74例无症状患者接受了保守治疗，或确诊或治疗被推迟。最长观察期为22年。总共有33例（45%）无症状患者最终出现了需要手术的症状。没有证据表明囊肿相关并发症后进行手术会增加术后发病率或死亡率，不过据指出这会增加手术的技术难度。没有关于将恶性肿瘤误诊为支气管源性囊肿的描述，但在研究的683个囊肿中，有5个（0.7%）被发现囊肿壁中有恶性细胞。然而，所引用的数据仅代表有症状或偶然发现的病例。由于这些原本良性病变的患病率未知，进展为有症状和相关恶性肿瘤的发生率可能低于所描述的情况。我们建议告知被诊断为支气管源性囊肿的无症状患者，手术（无论立即进行还是推迟）有20%的发病率、45%出现症状的风险（其中一些可能很严重）以及0.7%的恶变风险。如果患者选择保守治疗，只有在能够保证密切长期随访的情况下才能提供这种选择。
