tailieunhanh - Difficult Decisions in Thoracic Surgery - part 6

Mặc dù những mối quan tâm tăng về nguy cơ của khát vọng trong loạt trường hợp, các nghiên cứu thuần tập và thử nghiệm ngẫu nhiên không chỉ ra một nguy cơ cao hơn đáng kể các sự kiện đường hô hấp có thể gây tử vong khi không được thực hiện một thủ tục thoát dạ dày | 252 . Hagen and . Peyre one patient 2 was reported to die postopera-tively from pulmonary aspiration. In spite of the concerns raised regarding the risk of aspiration in the case series the cohort studies and randomized controlled trials do not indicate a significantly higher risk of potentially fatal respiratory events when a gastric drainage procedure is not performed. Interestingly the two cohort studies that specifically addressed this issue both reported a slightly higher rate of aspiration when gastric drainage was performed. The difference was not statistically significant. Wang and coworkers20 reported signs or symptoms of aspiration in 17 of patients who had a gastric drainage procedure compared to only 3 when drainage was not performed. Finley and colleagues24 reported an identical 17 frequency of aspiration in 249 patients who had a pyloroplasty compared to an 11 frequency of aspiration in the 46 patients who did not have a gastric drainage procedure. The frequency of respiratory complications has been reported in two randomized controlled trials. In the first Mannell and colleagues14 randomized 40 patients to reconstruction with and without a pyloroplasty. Clinical outcome was assessed 8 months after surgery. Three patients in the no pyloroplasty group died of postoperative aspiration with an additional death during late follow-up due to aspiration. There were no major pulmonary complications early or late when a pyloroplasty was performed. This difference in frequency of aspiration 20 without pyloroplasty vs. 0 with pyloroplasty did not reach statistical significance p most likely due to the small number of patients randomized. In the second randomized controlled trial Fok and associates16 randomized 200 patients each to pyloroplasty or gastric reconstruction without a drainage procedure. Once again pulmonary aspiration was more common in the no pyloroplasty group including two deaths but the difference did not reach statistical significance