Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
Ann Thorac Surg. 2018 Apr;105(4):1065-1070. doi: 10.1016/j.athoracsur.2017.11.011. Epub 2018 Feb 14.
Postoperative chylothorax in children is associated with an increased risk of vascular thrombosis, hypothesized to be from loss of antithrombin into chylous fluid resulting in a hypercoagulable state. In adults, an increased thrombotic risk with chylothorax has not been described. Adults undergoing Ivor-Lewis esophagogastrectomy have two strong thrombotic risk factors-active malignancy and postoperative state-allowing for relative homogeneity in baseline thrombotic risk; therefore, we studied the association of chylothorax with thrombosis in this population.
We performed a single-center retrospective cohort study at a tertiary care academic center. Patients included adults undergoing Ivor-Lewis esophagogastrectomy between January 1, 2006, and December 31, 2012. We collected demographics, pleural fluid characteristics, and relevant imaging within 30 days after the operation. Using nominal logistic regression, we studied the effects of chylothorax, age, sex, body mass index, American Society of Anesthesiologists Physical Status Classification, operative duration, and hospital length of stay on the incidence of postoperative thrombosis.
We identified 608 patients who underwent Ivor-Lewis esophagogastrectomy. Of these, 524 (86.2%) had no pleural fluid analysis, 48 (7.9%) had nonchylous effusions, and 36 (5.9%) had chylothoraces, with incident acute vascular thrombosis within 30 days postoperatively occurring in 22 of 524 (4.2%), 2 of 48 (4.2%), and 8 of 36 (22.2%), respectively (p = 0.001). In multivariate analyses, after adjusting for the above factors, chylothorax was associated with significantly higher odds of any vascular thrombosis (odds ratio, 5.46; p = 0.0013) and deep venous thrombosis/pulmonary embolism (odds ratio, 6.76; p = 0.0016).
Chylothorax is associated with a significantly higher incidence of vascular thrombosis in adults undergoing Ivor-Lewis esophagogastrectomy. Vascular thrombosis was associated with a significantly higher 90-day mortality rate.
儿童术后乳糜胸与血管血栓形成的风险增加有关，据推测是由于抗凝血酶进入乳糜液中导致高凝状态。在成年人中，乳糜胸与血栓形成的相关性尚未被描述。接受 Ivor-Lewis 食管胃切除术的成年人有两个强烈的血栓形成危险因素——活动性恶性肿瘤和术后状态，这使得基线血栓形成风险相对一致；因此，我们在该人群中研究了乳糜胸与血栓形成的关系。
我们在一家三级保健学术中心进行了单中心回顾性队列研究。研究对象包括 2006 年 1 月 1 日至 2012 年 12 月 31 日期间接受 Ivor-Lewis 食管胃切除术的成年人。我们收集了术后 30 天内的人口统计学、胸腔积液特征和相关影像学资料。使用名义逻辑回归，我们研究了乳糜胸、年龄、性别、体重指数、美国麻醉医师协会身体状况分类、手术时间和住院时间对术后血栓形成发生率的影响。
我们确定了 608 例接受 Ivor-Lewis 食管胃切除术的患者。其中，524 例（86.2%）未进行胸腔积液分析，48 例（7.9%）为非乳糜性积液，36 例（5.9%）为乳糜胸，术后 30 天内发生急性血管血栓形成的患者分别为 22 例（4.2%）、2 例（4.2%）和 8 例（22.2%）（p=0.001）。在多变量分析中，在调整上述因素后，乳糜胸与任何血管血栓形成的发生几率显著相关（比值比，5.46；p=0.0013）和深静脉血栓形成/肺栓塞（比值比，6.76；p=0.0016）。
在接受 Ivor-Lewis 食管胃切除术的成年人中，乳糜胸与血管血栓形成的发生率显著增加相关。血管血栓形成与 90 天死亡率显著升高相关。
