Wu Darrell, Chesnokova Arina E, Akvan Shahab, Price Matt D, Sugarbaker David J, Coselli Joseph S, LeMaire Scott A
Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas.
Semin Thorac Cardiovasc Surg. 2018 Summer;30(2):215-219. doi: 10.1053/j.semtcvs.2018.02.005. Epub 2018 Feb 8.
Chylothorax is a potentially deadly complication that can occur after thoracoabdominal aortic aneurysm (TAAA) repair. We describe our contemporary experience (2005-2014) with this complication, our efforts to identify perioperative variables associated with it, and our attempts to assess treatment outcomes. We reviewed the records of 1092 consecutive patients who underwent TAAA repair between 2005 and 2014. Standard bivariate analysis was used to test for between-group differences. Eleven patients (0.9%) developed postoperative chylothorax. Nonoperative management was used in 8 of these patients (73%); 1 patient died after a lengthy hospital stay (297 days). The other 3 patients required thoracotomy with direct ligation; 1 of these patients required a second operation. Patients who developed chylothorax appeared to be similar to other patients in age, sex, extent of aneurysm, and metabolic or cardiovascular comorbidities. Patients who developed postoperative chylothorax were more likely to require drainage of a pleural effusion (P = 0.005), tracheostomy (P = 0.02), and longer stays in the intensive care unit (median, 6 [2-24] days, P < 0.001) and the hospital (median, 35 [24-88] days, P = 0.001), and these patients were more likely to develop a graft infection (n = 2, P < 0.001). The extent of TAAA repair (Crawford I-IV), reoperation, and clamping proximal to the left subclavian artery were not significantly associated with postoperative chylothorax. Chylothorax after TAAA repair can often be managed nonoperatively. Development of postoperative chylothorax may lead to significant morbidity, longer hospitalization, and increased likelihood of graft infection.
乳糜胸是胸腹主动脉瘤（TAAA）修复术后可能出现的一种潜在致命并发症。我们描述了我们在2005年至2014年期间处理该并发症的当代经验、识别与之相关的围手术期变量的努力以及评估治疗结果的尝试。我们回顾了2005年至2014年间连续接受TAAA修复的1092例患者的记录。采用标准双变量分析来检验组间差异。11例患者（0.9%）发生了术后乳糜胸。其中8例患者（73%）采用了非手术治疗；1例患者在长时间住院（297天）后死亡。另外3例患者需要开胸直接结扎；其中1例患者需要再次手术。发生乳糜胸的患者在年龄、性别、动脉瘤范围以及代谢或心血管合并症方面似乎与其他患者相似。发生术后乳糜胸的患者更有可能需要胸腔积液引流（P = 0.005）、气管切开（P = 0.02），在重症监护病房的住院时间更长（中位数为6[2 - 24]天，P < 0.001），在医院的住院时间更长（中位数为35[24 - 88]天，P = 0.001），并且这些患者更有可能发生移植物感染（n = 2，P < 0.001）。TAAA修复的范围（Crawford I - IV）、再次手术以及在左锁骨下动脉近端夹闭与术后乳糜胸无显著相关性。TAAA修复术后的乳糜胸通常可以采用非手术治疗。术后乳糜胸的发生可能导致严重的发病率、更长的住院时间以及移植物感染可能性增加。
