电视辅助胸腔镜肺大疱切除术后单管引流疗效的观察

CLINICAL OBSERVATION OF CLOSED THORACIC DRAINAGE WITH SINGLE TUBE AFTER RESECTION OF LUNG BULLAE BY VATS

目的通过观察电视辅助胸腔镜手术(video-assisted thoracic surgery,VATS)肺大疱切除术后单管引流的效果来评价单管胸腔引流的应用价值。方法选取患有肺大疱和/或气胸需住院手术治疗患者共168例,随机分为二组。A组95例,术后采用单管引流;B组73例,术后采用传统双管引流。A组手术结束后经胸腔镜切口放置胸腔闭式引流管1根在胸腔镜辅助下将引流管放置至距胸膜腔顶2cm左右位置,以防术后胸管刺激胸壁导致疼痛及副损伤。引流管根据切口距胸膜顶位置增加侧孔。B组采用传统双管引流方法,手术结束后经胸腔镜切口及手术切口分别放置胸腔闭式引流管各1根。术后观察患者疼痛、胸引量、肺膨胀情况、胸管无积气排出时间及拔管时间。结果术后平均疼痛程度评分A组(1.67±1.12)分,B组(2.23±1.24)分,二组差异有统计学意义(P<0.05)。A组拔管前总引流量(408±161)ml,B组(412±133)ml,二组比较差异无统计学意义(P>0.05)。术后拔管时间A组(51.39±7.44)h,B组(50.64±8.31)h;术后无积气排出时间A组(21.71±12.37)h,B组(23.89±12.66)h,二组对比差异均无统计学意义(P>0.05)。A组术后发生肺不张3例,B组发生肺不张2例,经积极处理后恢复良好。二组肺不张发生率对比差异无统计学意义(P>0.05)。结论单管引流用于肺大疱及气胸术后引流是安全、有效地,并且可以减少患者疼痛,值得推广。

Objective To observe the effect of closed thoracic drainage with single tube after resection of lung bullae by Video-assisted thoracoscopic surgery（VATS）,and evaluate the value of the application of thoracic drainage with single tube.Methods A total of 168 patients with pulmonary bulla and/or pneumothorax who required hospitalization operation were randomly divided into two groups.Group A,95 cases,used single tube thoracic drainage after operation;Group B,73 cases,used double tube drainage after operation.At the end of operation,group A were placed closed thoracic drainage with one tube through thoracoscopic incision;Group B used the traditional double tube drainage method,through thoracoscopic incision and operation incision.Postoperative pain,the volume of thoracic drainage,the incidence of atelectasis,no-gas-exhaust time of chest tube and extubation time were recorded.Results The average postoperative pain score in group A was（1.67±1.12）,in group B was（2.23±1.24）,with significant difference between the two groups（P〈0.05）.The total drainage volume before extubation of group A was（408±161）ml,group B was（412±133）ml,and there was no statistically significance（P〉0.05）between the two groups.The extubation time in group A was（21.71±12.37）h,group B was（23.89±12.66）h;no-gas-exhaust time after operation in group A was（2.032±0.605）h,group B was（29.548 ± 5.221）h,and there was no statistically significance（P〉0.05）between the two groups.There were 3 cases of atelectasis after operation in group A,and2 cases in group B,and all the patients recovered very well after right treatment.The incidence rate of pulmonary atelectasis had no statistical significance（P〉0.05）between the two groups.Conclusion The method of thoracic drainage with single tube for lung bullae and pneumothorax after operation is safe,effective,and can reduce the pain of patients,and is worthy of promotion in clinic.