Departament of Gastroenterology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil.
Departament of Evidence-Based Medicine, Faculdade de Medicina, Centro Universitário Lusíada, Santos, São Paulo, Brazil.
Braz J Cardiovasc Surg. 2023 Oct 6;38(6):e20220326. doi: 10.21470/1678-9741-2022-0326.
Chylothorax after thoracic surgery is a severe complication with high morbidity and mortality rate of 0.10 (95% confidence interval [CI] 0.06 - 0.02). There is no agreement on whether nonoperative treatment or early reoperation should be the initial intervention. This systematic review and meta-analysis aimed to evaluate the outcomes of the conservative approach to treat chyle leakage after cardiothoracic surgeries.
A systematic review was conducted in PubMed®, Embase, Cochrane Library Central, and LILACS (Biblioteca Virtual em Saúde) databases; a manual search of references was also done. The inclusion criteria were patients who underwent cardiothoracic surgery, patients who received any nonoperative treatment (e.g., total parenteral nutrition, low-fat diet, medium chain triglycerides), and studies that evaluated chylothorax resolution, length of hospital stay, postoperative complications, infection, morbidity, and mortality.
Nonoperative treatment for chylothorax after cardiothoracic procedures has significant hospital stay, morbidity, mortality, and reoperation rates.
Twenty-two articles were selected. Pulmonary complications, infections, and arrhythmia were the most common complications after surgical procedures. The incidence of chylothorax in cardiothoracic surgery was 1.8% (95% CI 1.7 - 2%). The mean time of maintenance of the chest tube was 16.08 days (95% CI 12.54 - 19.63), and the length of hospital stay was 23.74 days (95% CI 16.08 - 31.42) in patients with chylothorax receiving nonoperative treatment. Among patients that received conservative treatment, the morbidity event was 0.40 (95% CI 0.23 - 0.59), and reoperation rate was 0.37 (95% CI 0.27 - 0.49). Mortality rate was 0.10 (95% CI 0.06 - 0.02).
Nonoperative treatment for chylothorax after cardiothoracic procedures has significant hospital stay, morbidity, mortality, and reoperation rates.
胸外科手术后发生乳糜胸是一种严重的并发症，其发病率和死亡率为 0.10（95%置信区间 [CI] 0.06-0.02）。对于非手术治疗还是早期再次手术应作为初始干预，目前尚无共识。本系统评价和荟萃分析旨在评估心胸手术后保守治疗乳糜胸漏的结果。
在 PubMed®、Embase、Cochrane 图书馆中心和 LILACS（虚拟健康图书馆）数据库中进行系统评价，同时还进行了参考文献的手动搜索。纳入标准为接受心胸外科手术的患者、接受任何非手术治疗（如全肠外营养、低脂饮食、中链甘油三酯）的患者，以及评估乳糜胸缓解、住院时间、术后并发症、感染、发病率和死亡率的研究。
心胸手术后非手术治疗乳糜胸的住院时间、发病率、死亡率和再次手术率显著较高。
共选择了 22 篇文章。手术后最常见的并发症是肺部并发症、感染和心律失常。心胸外科手术后乳糜胸的发生率为 1.8%（95%CI 1.7-2%）。接受非手术治疗的乳糜胸患者留置胸腔引流管的平均时间为 16.08 天（95%CI 12.54-19.63），住院时间为 23.74 天（95%CI 16.08-31.42）。接受保守治疗的患者中，发病率事件为 0.40（95%CI 0.23-0.59），再次手术率为 0.37（95%CI 0.27-0.49）。死亡率为 0.10（95%CI 0.06-0.02）。
心胸手术后非手术治疗乳糜胸的住院时间、发病率、死亡率和再次手术率显著较高。
