胸腔镜肺叶切除术后两种单根胸腔闭式引流方法的效果比较

Comparison of the clinical effect of single thoracic closed drainage with two different methods after thoracoscopic pulmonary lobectomy

目的比较胸腔镜肺叶切除术后两种不同单根胸腔闭式引流方法的引流效果。方法行胸腔镜肺叶切除的患者177例，根据其术后留置胸腔引流管方式的不同，将其分为两组，软管组（28F-蕈形引流管，前端置入胸膜腔顶，胸膜腔底部留置侧孔）和硬管组（普通硬质胸腔引流管，置入胸膜腔深度3～5cm，前端留置侧孔），比较两组患者术后胸腔引流量、胸腔引流管带管时间、住院时间、术后疼痛评分以及术后皮下气肿发生率。结果两组患者性别、年龄、手术部位及病理类型比较差异无统计学意义（P〉0．05）。软管组患者术后疼痛评分为（4．31±0．22）分，硬管组为（5．22±0．19），两组比较差异有统计学意义P〈0．05）；上肺叶切除患者术后采用软管引流方法，其术后带管时间、住院时间及术后皮下气肿发生率分别为（3．92±1．85）天、（6．81±1．65）天和12．9％，硬管组分别为（4．61±2．36）天，（8．87±2．21）天和31．4％，两组比较差异有统计学意义P〈0．05或〈0．01）。对于下肺叶切除的患者，软管引流除了减少疼痛刺激以外，其他方面比较差异均无统计学意义。结论前端置入胸膜腔顶部、底部留置侧孔的单根软管胸腔闭式引流更适合于胸腔镜肺叶切除的患者，尤其是上肺叶切除的患者。

Objective To evaluate the the clinical effect of single thoracic closed drainage with two different methods after thoracoscopic pulmonary lobectomy. Methods 117 patients who underwent thoracoscopic pulmonary lobeetomy between March 2014 and March 2015 in thoracic surgery department of Xiang-Ya Hospital,Centrol South University were included in this study. All the patients were divided into two groups, one group with soft tubes （28F-Mushroom drainage tube with side holes at the bottom and the front end was placed at the top of pleural cavity） , and the other group with hard tube （ ordinary hard tube with side hole at front end and inserted into pleural cavity with the depth of 3 -5cm ）. The amount of drainage, the duration time with tube, hospitalization days, pain severity score and incidence of subcutane- ous emphysema after surgery were recorded and analyzed. Results There were no statistical significance in the gender,age, operation sites and pathological category between two groups （P 〉 0.05 ）. The pain score in the group with soft tube is lower than the group with hard tube （ 4.31 ±0.22 vs 5.22 ± 0.19, P 〈 0.05 ）. For the patients underwent upper pulmonary lobectomy, the group with soft tube showed shorter duration of drainage and hospitalization days and lower incidence of postoperative subcutaneous emphysema （3.92 ±1.85vs4.61±2.36,P〈0.05;6.81±1.65vs8.87±2.21,P〈0. 05;12.9% vs31.4%,P〈 0.01 ） , especially in subcutaneous emphysema （P 〈 0.01 ）. But for lower pulmonary lobectomy, there were no significant difference except for the pain score. Conclusion The way of single thoracic drainage tube with side holes at the bottom and the front end into the top of pleural cavity is more suitable for the pa- tients with thoracoscopic lobectomy, especially for the patients received upper pulmonary lobectomy.