Czobor Nikoletta R, Roth György, Prodán Zsolt, Lex Daniel J, Sápi Erzsébet, Ablonczy László, Gergely Mihály, Székely Edgar A, Gál János, Székely Andrea
School of PhD Studies, Semmelweis University, Budapest, Hungary.
Department of Pediatric Cardiac Surgery, Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary.
J Thorac Dis. 2017 Aug;9(8):2466-2475. doi: 10.21037/jtd.2017.07.88.
The occurrence of postoperative chylothorax in children with congenital heart disease is a rare and serious complication in cardiac intensive care units (ICUs). The aim of our study was to identify the perioperative characteristics, treatment options, resource utilization and long term complications of patients having chylothorax after a pediatric cardiac surgery.
Patients were retrospectively assessed for the presence of chylothorax between January 2002 and December 2012 in a tertiary national cardiac center. Occurrence, treatment options and long term outcomes were analyzed. Chylothorax patients less than 2 years of age were analyzed using propensity-matched statistical analysis in regard to postoperative complications after discharge.
During the 10-year period, 48 patients had chylothorax after pediatric cardiac surgery. The highest incidence was observed on the second postoperative day (7 patients, 14.6%). Seven patients (14.6% of the chylothorax population) died. During the follow up period, 5 patients had additional thromboembolic complications (2 had confirmed thrombophilia). Eleven patients had a genetic abnormality (3 had Down's syndrome, 3 had Di-Giorge's syndrome, 1 had an IgA deficiency and 4 had other disorders). During the reoperations (49 cases), no chylothorax occurred. After propensity matching, the occurrence of pulmonary failure (P=0.001) was significantly higher in the chylothorax group, and they required prolonged mechanical ventilation (P=0.002) and longer hospitalization times (P=0.01). After discharge, mortality and neurologic and thromboembolic events did not differ in the matched groups.
Chylothorax is an uncommon complication after pediatric cardiac surgery and is associated with higher resource utilization. Chylothorax did not reoccur during reoperations and was not associated with higher mortality or long-term complications in a propensity matched analysis.
先天性心脏病患儿术后乳糜胸是心脏重症监护病房（ICU）中一种罕见且严重的并发症。我们研究的目的是确定小儿心脏手术后发生乳糜胸患者的围手术期特征、治疗选择、资源利用情况及长期并发症。
回顾性评估2002年1月至2012年12月期间在一家国家级三级心脏中心接受治疗的患者乳糜胸的发生情况。分析其发生率、治疗选择及长期预后。对年龄小于2岁的乳糜胸患者采用倾向匹配统计分析其出院后的术后并发症。
在这10年期间，48例小儿心脏手术后出现乳糜胸。术后第二天发病率最高（7例，14.6%）。7例患者（占乳糜胸患者的14.6%）死亡。在随访期间，5例患者出现额外的血栓栓塞并发症（2例确诊为血栓形成倾向）。11例患者存在基因异常（3例患有唐氏综合征，3例患有迪格奥尔格综合征，1例患有IgA缺乏症，4例患有其他疾病）。再次手术（49例）期间未发生乳糜胸。倾向匹配后，乳糜胸组发生肺衰竭的比例显著更高（P = 0.001），且需要更长时间的机械通气（P = 0.002）和更长的住院时间（P = 0.01）。出院后，匹配组的死亡率、神经及血栓栓塞事件无差异。
乳糜胸是小儿心脏手术后一种不常见的并发症，且与更高的资源利用相关。在倾向匹配分析中，再次手术期间乳糜胸未复发，且与更高的死亡率或长期并发症无关。
