| Objective:Acute type A aortic dissection(ATAAD)is the most dangerous aortic disease.Total arch replacement combined with stented elephant trunk implantation(Sun’s procedure)has become the standard surgical procedure for type A dissection,which Chylous leakage is one of the common complications after ATAAD.Clinical case data of patients with ATAAD in the Clinical Medical Center of Vascular Surgery in the First People’s Hospital of Yunnan Province were collected,risk factors of chylous leakage after Sun’s procedure of ATAAD were analyzed,and treatment plans for chylous leakage were summarized,so as to reduce the occurrence of chylous leakage after Sun’s procedure of ATAAD and provide reference for the standard treatment of chylous leakage in vascular surgery.Methods:Clinical data of patients admitted to the Clinical Medical Center of Vascular Surgery in the First People’s Hospital of Yunnan Province from June 1 2018 to March 31 2021 who received Sun’s procedure were collected.According to the conditions of thoracic drainage,the case data were divided into chylous leakage group and non-chylous leakage group.Risk factor indexes of the two groups were compared and analyzed: Preoperative serum albumin,lymphocyte count,body mass index(BMI),liver function index,kidney function index,cardiac function index,prognostic nutrition index(PNI),ejection fraction(EF),and intraoperative extracorporeal circulation time.Analyze the correlation between the above factors and the occurrence of chylous leakage,and analyze the risk factors of chylous leakage after Sun’s procedure of ATAAD.Prognostic indicators of patients in chylous leakage group and non-chylous leakage group were compared: Length of stay,total hospital cost,catheter duration of drainage tube,incidence of nosocomial infection,and 30 days postoperative mortality.The difference of above clinical indexes between the two groups was analyzed for statistical significance.Summarize the treatment of chylous leakage patients and analyze the effectiveness of the treatment.Results:From June 1 2018 to March 31 2021,150 patients with ATAAD,including 107 males and 43 females,were admitted to the Clinical Medical Center of Vascular Surgery in the First People’s Hospital of Yunnan Province and received Sun’s procedure.The mean age was 51.2(range 30～78)years.There were 30 cases of chylous leakage,including 20 males and 10 females.The mean age was 51.7(range 34～74)years,the mean serum albumin was 36.37±4.42 g/l,the mean BMI was 24.20±4.80,and the mean PNI was157.34±26.45,the mean time of extracorporeal circulation was 147.77±33.34 minutes.There were 9 cases of abnormal liver function,24 cases of abnormal kidney function and 14 cases of cardiac insufficiency before operation.The mean length of stay was 25.53±7.52 days,the mean hospitalization cost was238037.55±71259.69 yuan,the mean drainage tube length was 15.13±3.60 days.There were 22 cases of nosocomial infection and 3 cases died 30 days after operation.All patients diagnosed with chylous leakage were cured after nonoperative treatment.There were 120 cases of non-chylous leakage,including 87 males and 33 females.The mean age was 51.1(range 30～78)years,the mean serum albumin was 37.17±3.92 g/l,the mean BMI was 24.62±4.04,and the mean PNI was160.28±20.53,the mean time of extracorporeal circulation was 142.03±39.50 minutes.There were 37 cases of abnormal liver function,21 cases of abnormal kidney function and 40 cases of cardiac insufficiency before operation.The mean length of stay was 19.99±6.65 days,the mean hospitalization cost was181761.85±42281.71 yuan,the mean duration of drainage tube was10.61±2.74 days.And there were 37 cases of nosocomial infection and 4 cases died 30 days after operation.Serum albumin level,BMI,PNI,extracorporeal circulation time,EF and lymphocyte count were independent variables for binary Logistic regression analysis.By testing the coefficients of each variable,the final specific analysis showed that,BMI(p=0.476>0.05),PNI(p=0.458>0.05),extracorporeal circulation time(p=0.137>0.05),EF value(p=0.150> 0.05),lymphocyte count(p=0.912>0.05),Serum albumin level(p=0.584>0.05).Independent Chi-square test showed liver insufficiency(p=1>0.05),kidney insufficiency(p=0.96>0.05),cardiac insufficiency(p=0.25>0.05).In other words,abnormal liver function,abnormal kidney function,cardiac insufficiency,serum albumin level,BMI,PNI,extracorporeal circulation time,EF,and lymphocyte count were not independent risk factors for chylous leakage after Sun’s procedure of ATAAD.Random forest analysis shows,The influence of risk factors of chylous leakage after Sun’s procedure of ATAAD was in descending order: PNI,lymphocyte count,BMI,extracorporeal circulation time,serum albumin level,EF.The above factors have greater influence on chylous leakage after Sun’s procedure of ATAAD.Liver insufficiency,kidney insufficiency,cardiac insufficiency have less influence on chylous leakage after Sun’s procedure of ATAAD.Independent T test was performed for continuous data,including length of stay,hospitalization cost,catheter duration of drainage tube and chylous leakage.Independent Chi-square test was performed for the binary data,nosocomial infection rate,30-day postoperative mortality and chylous leakage.The length of stay(p=0.000<0.05),hospitalization cost(p=0.000<0.05),catheter duration of drainage tube(p=0.000<0.05),incidence of nosocomial infection(p=5.05e-05<0.05,),30 days postoperative mortality(p=0.29>0.05).Different chylous leakage samples showed significant differences in length of stay,hospital cost,catheter duration of drainage tube,and the incidence of nosocomial infection,but no significant difference in postoperative mortality at 30 days.Conclusions:Surgical injury of thoracic duct and its branch lymphatic duct is the main cause of chylous leakage after Sun’s procedure of ATAAD.Liver insufficiency,kidney insufficiency,cardiac insufficiency,serum albumin level,BMI,PNI,lymphocyte count,cardiopulmonary bypass time,EF all of them have a certain influence on chylous leakage after Sun’s procedure for ATAAD,but all of them were not independent risk factors for chylous leakage after Sun’s procedure for ATAAD.Chylous leakage after Sun’s procedure for ATAAD is the result of multiple factors.Chylous leakage after Sun’s procedure of ATAAD can significantly increase the length of hospital stay,hospitalization cost,length of drainage tube and incidence of nosocomial infection,but it does not significantly increase the mortality at 30 days after surgery.Nonsurgical treatment is safe and effective for chylous leakage after Sun’s procedure of ATAAD. |
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