Day Thomas G, Zannino Diana, Golshevsky Daniel, d'Udekem Yves, Brizard Christian, Cheung Michael M H
1Department of Cardiology,Royal Children's Hospital,Parkville,Victoria,Australia.
2Heart Research Group,Murdoch Children's Research Institute,Parkville,Victoria,Australia.
Cardiol Young. 2018 Feb;28(2):222-228. doi: 10.1017/S1047951117001731. Epub 2017 Aug 24.
The aims of this study were to investigate risk factors for the development of postoperative chylothorax following paediatric congenital heart surgery and to investigate the impact of a management guideline on management strategies and patient outcome.
All patients with chylothorax following cardiac surgery at the Royal Children's Hospital, Melbourne, over a 48-month period beginning in January 2008 were identified. A control group, matched for age, date of surgery, and sex, was identified. To investigate potential risk factors, univariable and multivariable logistic regression models were constructed with paired analysis. To examine the effect of a standardised management protocol, data before and after the implementation of the guideline were compared.
In total, 121 cases of chylothorax were identified, with 121 controls, matched for age at surgery, date of surgery, and sex. The incidence of chylothorax was 5.23%. Increasing surgical complexity (univariable OR 0.17 for the least complex versus the most complex group, p=0.02), closed-heart surgeries (OR 0.07 for open versus closed, p<0.001), and redo chest incisions (OR 10.0 for redo versus virgin, p<0.001) were significantly associated with chylothorax. The standardised management protocol had no significant impact on either drainage duration or management strategy.
We have replicated the previously reported association between surgical complexity and chylothorax risk, and have shown, for the first time, that redo chest openings are also associated with a significantly increased risk. The implementation of a standardised management protocol in our institution did not result in a significant change in either chylothorax drainage duration or management strategy.
本研究旨在调查小儿先天性心脏病手术后发生乳糜胸的危险因素，并探讨管理指南对管理策略和患者结局的影响。
确定了2008年1月开始的48个月期间在墨尔本皇家儿童医院接受心脏手术后发生乳糜胸的所有患者。确定了一个年龄、手术日期和性别相匹配的对照组。为了调查潜在的危险因素，构建了单变量和多变量逻辑回归模型并进行配对分析。为了检验标准化管理方案的效果，比较了指南实施前后的数据。
总共确定了121例乳糜胸病例，有121名对照，在手术年龄、手术日期和性别方面相匹配。乳糜胸的发生率为5.23%。手术复杂性增加（最不复杂组与最复杂组相比，单变量OR为0.17，p = 0.02）、心脏闭式手术（开胸手术与闭式手术相比，OR为0.07，p < 0.001）以及再次胸部切口（再次手术与初次手术相比，OR为10.0，p < 0.001）与乳糜胸显著相关。标准化管理方案对引流持续时间或管理策略均无显著影响。
我们重复了先前报道的手术复杂性与乳糜胸风险之间的关联，并且首次表明再次胸部开口也与显著增加的风险相关。在我们机构实施标准化管理方案并未导致乳糜胸引流持续时间或管理策略发生显著变化。
