Mirhosseini Seyed Mohsen, Fakhri Mohammad, Mozaffary Amirhossein, Lotfaliany Mojtaba, Behzadnia Neda, Ansari Aval Zahra, Ghiasi Seyed Mohammad Saeed, Boloursaz Mohammad Reza, Masjedi Mohammad Reza
Chronic Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Interact Cardiovasc Thorac Surg. 2013 Apr;16(4):495-500. doi: 10.1093/icvts/ivs491. Epub 2012 Dec 18.
The optimal management and treatment of pericardial effusion are still controversial. There is limited data related to the risk factors affecting survival in these patients. The aim of this study was to determine the risk factors affecting the survival rate of patients with symptomatic pericardial effusion who underwent surgical interventions.
From 2004 to 2011, we retrospectively analysed 153 patients who underwent subxiphoid pericardial window as their surgical intervention to drain pericardial effusions at the National Research Institute of Tuberculosis and Lung diseases (NRITLD). To determine the effects of risk factors on survival rate, demographic data, clinical records, echocardiographic data, computed tomographic and cytopathological findings and also operative information of patients were recorded. Patients were followed annually until the last clinical follow-up (August 2011). To determine the prognostic factors affecting survival, both univariate analysis and multivariate Cox proportional hazards model were utilized.
There were 89 men and 64 women with a mean age of 50.3 ± 15.5 years. The most prevalent symptom was dyspnoea. Concurrent malignancies were present in 66 patients. Lungs were the most prevalent primary site for malignancy. The median duration of follow-up was 15 (range 1-85 months). Six-month, 1-year and 18-month survival rates were 85.6, 61.4 and 36.6%, respectively. In a multivariate analysis, positive history of lung cancer (hazard ratio [HR] 2.894, 95% confidence interval [CI] 1.362-6.147, P = 0.006) or other organ cancers (HR 2.315, 95% CI 1.009-50311, P = 0.048), presence of a mass in the computed tomography (HR 1.985, 95% CI 1.100-3.581, P = 0.023), and echocardiographic findings compatible with tamponade (HR 1.745, 95% CI 1.048-2.90 P = 0.032) were the three independent predictors of postoperative death.
In the surgical management of pericardial effusion, patients with underlying malignant disease, especially with lung cancer, patients with a detectable invasion of thorax in computed tomography and those with positive echocardiographic findings compatible with tamponade have a poor survival. Therefore, minimally invasive therapies could be considered as a more acceptable alternative for these high-risk patients.
心包积液的最佳管理和治疗仍存在争议。关于影响这些患者生存的危险因素的数据有限。本研究的目的是确定影响接受手术干预的有症状心包积液患者生存率的危险因素。
2004年至2011年，我们回顾性分析了153例在国家结核病和肺部疾病研究所（NRITLD）接受剑突下心包开窗术作为心包积液引流手术干预的患者。为了确定危险因素对生存率的影响，记录了患者的人口统计学数据、临床记录、超声心动图数据、计算机断层扫描和细胞病理学检查结果以及手术信息。对患者进行每年一次的随访，直至最后一次临床随访（2011年8月）。为了确定影响生存的预后因素，采用了单因素分析和多因素Cox比例风险模型。
有89名男性和64名女性，平均年龄为50.3±15.5岁。最常见的症状是呼吸困难。66例患者同时患有恶性肿瘤。肺部是最常见的恶性肿瘤原发部位。中位随访时间为15个月（范围1 - 85个月）。6个月、1年和18个月的生存率分别为85.6%、61.4%和36.6%。在多因素分析中，肺癌阳性病史（风险比[HR]2.894，95%置信区间[CI]1.362 - 6.147，P = 0.006）或其他器官癌症（HR 2.315，95% CI 1.009 - 50311，P = 0.048）、计算机断层扫描显示有肿块（HR 1.985，95% CI 1.100 - 3.581，P = 0.023）以及与心包填塞相符的超声心动图表现（HR 1.745，95% CI 1.048 - 2.90，P = 0.032）是术后死亡的三个独立预测因素。
在心包积液的手术治疗中，患有潜在恶性疾病的患者，尤其是肺癌患者、计算机断层扫描显示有胸部可检测到的侵犯的患者以及超声心动图表现与心包填塞相符的患者生存率较差。因此，对于这些高危患者，微创治疗可被视为更可接受的替代方案。
