单操作孔胸腔镜胸腺切除术后不留置胸腔引流管的临床研究

The clinical study of non - drainage tube after single - port video - assisted thoracoscopic thymectomy

目的探讨重症肌无力患者行单操作孔胸腔镜胸腺切除术后不留置胸腔引流管的可行性。 方法采用单操作孔胸腔镜胸腺切除术治疗的重症肌无力患者63例，根据术后是否留置胸腔引流装置分为两组：对照组38例，于一侧肋间留置胸腔闭式引流管；实验组25例，不留置胸腔引流管，胸膜腔内引流。采用独立样本t检验分析疼痛持续时间、术后疼痛评分、术后住院时间等指标。 结果对照组与实验组比较：疼痛持续时间[（32.7±10.2） h比（14.2±2.9） h，P＝0.000]、术后疼痛评分[（2～6）3.8分比（1～5）2.4分，P＝0.000]、术后住院时间[（5.6±1.0） d比（4.9±0.7） d，P＝0.016]，差异有统计学意义。实验组未留置胸腔引流管，对照组术后胸腔引流液量为（60.8±9.5） ml，引流时间为（23.6±8.7） h，实验组引流液量及引流时间均低于对照组，差异有统计学意义（P＝0.000）。术后3 d查胸部CT显示：对照组38例有少量胸腔积液（〈50 ml），未见积气；实验组25例有少量胸腔积液（〈150 ml），2例有少量胸腔积气（〈10%），两组均不需要胸腔穿刺排液或排气。术后1个月查胸部CT示：两组均未见明显胸腔积液量（〈30 ml），未见积气，不需要胸腔穿刺排液。 结论单操作孔胸腔镜胸腺切除术后不留置胸腔引流管创伤小，疼痛轻，恢复快，安全可行。

Objective To assess the feasibility of non -drainage tube after single -port video - assisted thoraeoseopie thymectomy in patients with myasthenia gravis （ MG ）. Methods According to whether the thoracic drainage tube was placed after thymectomy, the patients with MG were divided into control group （38 cases） and experimental group （25 cases）. The thoracic drainage tube was inserted be- tween the ribs in the control group, and not placed in the experimental group. The clinical data including duration and score of post - operative chest pain and post - operative hospital stay were recorded and ana- lyzed by independent samples t test. Results There was statistically significant difference between the two groups in the duration of post - operative chest pain [ （ 32. 7 ± 10. 2） h vs. （ 14. 2 ± 2. 9） h, P = 0. 000] , the score of post - operative chest pain [ （2 - 6 ） 3.8 scores vs. （ 1 - 5 ） 2.4 scores,P = 0. 000 ], duration of post - operative hospital stay [ （5.6 ± 1.0） days vs. （4. 9 ±0. 7） days, P =0. 016], post - operative chest drainage time [ （23.6 ± 8.7） h vs. （0） d, P = 0. 000 ] and post - operative thoracic drainage volume [ （60. 8 ±9. 5） ml vs. （0） ml, P =0. 000]. At 3rd day after operation, the results of the chest CT examination showed 38 cases in the control group had a small amount of pleural effusion （ 〈 50 ml） and no pneumothorax, and 25 cases in the experimental group had a small amount of pleural effusion （ 〈 150 ml） and 2 cases had a small amount of pneumothorax （ 〈 10% ）. At first month after operation, the results of the chest CT examination showed that there were no significant pleural effusion （ 〈30 ml） and no pneumo- thorax in the two groups. Thoracentesis was not needed in the two groups after operation. Conclusion It is safe and feasible that thoracic drainage tube is not placed after single - port video - assisted thoracoscopic thymeetomy in patients with MG.