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首页> 美国卫生研究院文献>other >Prophylactic octreotide does not reduce the incidence of postoperative chylothorax following lobectomy
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Prophylactic octreotide does not reduce the incidence of postoperative chylothorax following lobectomy

机译：预防性奥曲肽不会降低肺叶切除术后术后乳糜胸的发生率

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Chylothorax after lobectomy is common, lacking reliable preventive measures. Octreotide is widely used for treatment of chyle leakage, but its role in preventing chylothorax has not been estimated. The aim of this study was to evaluate whether prophylactic octreotide could reduce the incidence of postoperative chylothorax.Patients who underwent lobectomy for lung cancer from January 2016 to September 2018 were retrospectively reviewed. The cases in prophylactic group received octreotide 1 day before the surgery until removal of chest tubes, while those in the control group did not use it unless the diagnosis of chylothorax.A total of 379 patients were enrolled, with 190 patients in control and 189 cases in prophylactic group. Octreotide was well tolerated in patients who received this agent. No 30-day mortality was indicated. Seven cases in control (3.7%, 7/190) and 3 cases in prophylactic group (1.6%, 3/189) with chylothorax were observed (P = .337). The patients in prophylactic group showed shorter duration of chest drainage ([3.6 ± 1.6] days vs [4.1 ± 2.0] days, P = .006) and reduced drainage volume ([441.8 ± 271.1] mL vs [638.7 ± 463.3] mL, P < .001). In addition, they showed similar stations and numbers of dissected lymph nodes, surgery-related complications, and postoperative hospital stay. Besides, 11 (5.8%, 11/190) patients in control and 6 (3.2%, 6/189) cases in the prophylactic group were readmitted for pleural effusion needing reinsertion of chest tubes (P = .321). Moreover, multivariable logistic analysis showed that induction therapy (odds ratio [OR] =12.03; 95% confidence interval [CI] 3.15–46.03, P < .001) was a risk factor, while high-volume experience of the surgeon (OR = 0.23; 95% CI 0.06–0.97, P = .045) was a preventive factor of surgery-related chylothorax. Additionally, prophylactic octreotide (OR = 0.18; 95% CI 0.11–0.28, P < .001) and perioperative low-fat diet (OR = 0.46; 95% CI 0.29–0.73, P = .001) were negatively associated with the drainage volume of pleural effusion. Furthermore, high-volume experience of the surgeon (OR = 6.03; 95% CI 1.30–27.85, P = .021) and induction therapy (OR = 8.87; 95% CI 2.97–26.48, P < .001) were risk factors of unplanned readmission.Prophylactic octreotide does not reduce the incidence of postoperative chylothorax or unplanned readmission following anatomic lobectomy. The routine application of octreotide should not be recommended. High-quality trials are required to validate these findings.
机译：肺叶切除术后的百日咳很常见，缺乏可靠的预防措施。奥曲肽广泛用于治疗乳糜渗漏，但尚未评估其在预防乳糜胸中的作用。这项研究的目的是评估预防性奥曲肽是否可以减少术后乳糜胸的发生率。回顾性分析2016年1月至2018年9月接受肺叶切除术的患者。预防组于手术前1天接受奥曲肽治疗直至拔除胸管，而对照组除非确诊乳糜胸才使用奥曲肽，共入组379例，对照组190例，189例。在预防组。接受这种药物的患者对奥曲肽的耐受性良好。没有显示30天的死亡率。观察到对照组有7例（3.7％，7/190）和预防组有3例（1.6％，3/189）有乳糜胸（P = .337）。预防组患者的胸腔引流时间较短（[3.6±1.6]天比[4.1±2.0]天，P = .006），引流量减少（[441.8±271.1] mL vs [638.7±463.3] mL， P <.001）。此外，他们显示出类似的淋巴结解剖部位和数目，与手术相关的并发症以及术后住院时间。此外，在预防组中有11例（5.8％，11/190）的对照患者和6例（3.2％，6/189）的患者再次进入胸腔积液，需要重新插入胸管（P = .321）。此外，多变量逻辑分析表明，诱导治疗（几率[OR] = 12.03； 95％置信区间[CI] 3.15–46.03，P <0.001）是一个危险因素，而外科医生的大量经验（OR = 0.23； 95％CI 0.06-0.97，P = 0.045）是与手术相关的乳糜胸的预防因素。此外，预防性奥曲肽（OR = 0.18; 95％CI 0.11-0.28，P <.001）和围手术期低脂饮食（OR = 0.46; 95％CI 0.29-0.73，P = .001）与引流负相关。胸腔积液量。此外，外科医生的大量经验（OR = 6.03; 95％CI 1.30–27.85，P = .021）和诱导治疗（OR = 8.87; 95％CI 2.97–26.48，P <.001）是导致癌症的危险因素。预防性奥曲肽不会降低术后肺乳糜胸的发生率或解剖性肺叶切除术后的计划外再次入院的发生率。不建议常规应用奥曲肽。需要高质量的试验来验证这些发现。

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