不保留胸腔引流管在微创肺癌术后加速康复外科中的临床研究

Clinical study on non-preservation of chest drainage tube in accelerated rehabilitation surgery after minimally invasive lung cancer surgery

目的探讨肺癌患者接受胸腔镜微创手术后不保留胸腔引流管促进加速康复的可行性和安全性。方法回顾性分析30例行胸腔镜微创肺癌手术后不保留胸腔引流管患者的临床资料,分析患者术后康复情况。结果 30例患者均顺利完成手术,其中肺叶切除术23例,肺叶楔形切除术7例;30例患者均行淋巴结清扫,无中转开胸。手术时间35~120 min,平均手术时间(70.6±16.5)min,术中出血量5~65 ml,平均术中出血量(19.6±15.2)ml。术后病理诊断腺癌23例,鳞状细胞癌6例,小细胞肺癌1例。30例患者术后均未出现严重并发症。所有患者术后第1天均已下地活动,并行床旁站立位胸部X线片检查,均未见气胸表现,2例患者提示有少量胸腔积液,均不需进一步处理或再次放置胸腔引流管。术后住院时间3~10 d,平均住院时间(6.5±1.2)d。出院后1个月复查胸部CT,所有患者均未见胸腔积液积气。结论部分肺癌患者接受胸腔镜微创手术后不保留胸腔引流管是安全可行的,符合加速康复外科理念。

Objective To discuss the feasibility and safety of non-preservation of chest drainage tube in accelerated rehabilitation surgery after minimally invasive surgery in patients with lung cancer. Methods The clinical data of 30 patients with non-preservation of chest drainage tube after minimally invasive lung cancer surgery were retrospectively analyzed, and their postoperative recovery condition was analyzed. Results The operation was successfully performed in 30 patients, including lobectomy in 23 cases, wedge resection in 7 cases, and lymph node dissection in 30 patients, and no patients in thoracotomy, with operation time as 35-120 min, mean operation time as（70.6±16.5） min, intraoperative bleeding voluem as 5-65 ml, and mean intraoperative bleeding voluem as（19.6±15.2） ml. There were adenocarcinoma in 23 cases, squamous cell carcinoma in 6 cases, small cell lung cancer in 1 case by postoperative pathological diagnosis. No serious complications were found in all 30 patients after operation. All patients had been moved down on 1 st day after operation. No pneumothorax was found in the chest X-ray examination of parallel bed standing position. 2 cases showed a small amount of pleural effusion, but no further treatment or drainage of thoracic drainage tube was needed. Postoperative hospitalization time was 3 -10 d, and mean hospitalization time was（6.5±1.2） d. Thoracic CT was reviewed 1 month after discharge and all patients had no pleural effusion. Conclusion It is safe and feasible for some lung cancer patients with non-preservation of chest drainage tube after minimally invasive surgery, and it is consistent with the concept of accelerated rehabilitation surgery.