负压吸引与常规引流对肺切除术后迁延性肺瘘的作用分析

Suction versus water seal for prolonged air leak after pulmonary resection：a randomized prospective study

目的研究分析持续负压吸引和常规闭式引流对肺切除术后迁延性肺瘘（PAL）中所起的作用和价值。方法将我院2004年3月至2011年5月203例肺切除术患者随机分为负压组（98例）和常规组（105例）。负压组于术后第一天胸腔引流管连接负压吸引装置，给予持续低负压吸引（压力为-10至-20cmH：O）。常规组手术后仅行常规的胸腔闭式引流。对两组并发症、PAL发生率以及漏气时间进行统计分析。结果本组共行肺切除术203例，发生迁延性肺瘘24例，发生率11．8％。负压组98例，出现并发症48例，其中迁延性肺瘘14例（14．3％）；常规组105例，出现并发症33例，其中迁延性肺瘘10例（9．5％）。负压组平均漏气时间5．3d，常规组4．9d，两组间差异无统计学意义（P〉0．05）；两组均无死亡病例。结论肺切除术后持续负压吸引并没有降低漏气持续时间以及PAL的发生率，在防治PAL的过程中持续负压吸引并不优于常规的闭式引流，不推荐肺切除术后常规使用负压吸引。

Objective To evaluate the efficacy of suction versus water seal of chest tubes in the management of prolonged air leak（PAL） after pulmonary resection. Methods Two hundred and three patients after pulmonary resection in Xianyang Central Hospital from March 2004 to May 2011 were prospectively randomly assigned to two groups：in suction group （98 patients）, chest tubes were placed on continuous low -pressure suction（ -10 cm H20 to -20 cm H20） on the morning of the first postoperative day; In water seal group （105 patients）, chest tubes were placed on water seal postoperatively. The complications, the rate of PAL and the duration of air leak in two groups were analyzed. Results A total of 203 patients underwent pulmonary resection, and PAL occurred in 24 cases （1l. 8% ）. In suction group ,48 patients had complications in which 14 patients were with PAL（ 14.3% ）. In water seal group, 33 patients had complications in which 10 patients were with PAL（9.5% ）. The average duration of air leaks was 5.3 d in suction group and 4.9 d in water seal group. There were no significant differences between the two groups. No deaths occurred in both groups. Conclusion Chest tubes on continuous low - pressure suction after pulmonary resection would not reduce the duration of air leak or the incidence of PAL compared with water seal. The routine use of chest tubes on continuous suction after pulmonary resection is not recommended.