Department of Thoracic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, China.
Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China.
J Cardiothorac Surg. 2022 May 19;17(1):122. doi: 10.1186/s13019-022-01868-w.
The clinical outcomes of delayed chest closure (DCC) compared with primary chest closure (PCC) following lung transplantation, including perioperative outcomes and long-term survival, remained controversial. This was the first systematic review and meta-analysis aimed to identify the short- and long-term outcomes of DCC following lung transplantation.
We comprehensively searched electronic literature from 4 databases up to April 1st, 2022. Dichotomous data and continuous data were pooled with odds ratio and weighted mean difference, respectively. The quality of included studies was assessed with the Newcastle-Ottawa Scale.
Ten studies were included in the systematic review and 4 studies were included in the meta-analysis. Pooled analysis showed that DCC was associated with an increased risk of surgical site infection, prolonged hospital stays, and higher risk of primary graft dysfunction compared to PCC. The 30 day and 5 year survival were higher in PCC cohort compared with DCC cohort while differences in survival at 6 months was insignificant.
Our findings do not support the aggressive application of DCC. DCC should be cautiously applied since its association with worse perioperative outcomes and higher mortality. But it remains the life-saving steps under dangerous circumstances.
与肺移植后的即刻关胸（PCC）相比，延迟关胸（DCC）的临床结果，包括围手术期结果和长期生存率，仍存在争议。这是首次旨在确定肺移植后 DCC 的短期和长期结果的系统评价和荟萃分析。
我们全面检索了截至 2022 年 4 月 1 日的 4 个数据库中的电子文献。二分类数据和连续数据分别采用比值比和加权均数差进行汇总。使用纽卡斯尔-渥太华量表评估纳入研究的质量。
系统评价纳入了 10 项研究，荟萃分析纳入了 4 项研究。汇总分析表明，与 PCC 相比，DCC 与手术部位感染风险增加、住院时间延长和原发性移植物功能障碍风险增加相关。与 DCC 组相比，PCC 组的 30 天和 5 年生存率更高，而 6 个月生存率的差异无统计学意义。
我们的研究结果不支持积极应用 DCC。由于 DCC 与围手术期结果较差和死亡率较高相关，因此应谨慎应用。但在危险情况下，它仍然是救命的步骤。
