经肋缘下胸腔镜胸腺扩大切除术中不常规留置纵隔引流管的临床研究

Clinical Research on No Mediastinal Tube Placement After Subcostal Thoracoscopic Extended Thymectomy

目的探讨经肋缘下胸腔镜胸腺扩大切除术中不常规留置纵隔引流管的安全性。方法回顾性分析2015年2月～2018年6月无大血管损伤和肺组织损伤的经肋缘下胸腔镜胸腺扩大切除术108例资料,2016年4月前32例常规留置纵隔引流管,以后76例不留置纵隔引流管。比较2组术后再次置管率、疼痛视觉模拟评分(Visual Analogue Scale,VAS)及术后住院时间。结果不引流组2例因气胸需术后放置胸腔闭式引流管,引流组均于术后第1天拔除纵隔引流管,无再次置管,2组术后再次置管率无统计学差异(P=1.000)。不引流组术后第1天VAS评分(2.9±0.8)显著低于引流组(4.5±0.8)(t=9.080,P=0.000),术后住院时间[(3.1±0.7) d]显著短于引流组[(4.0±0.6) d](t=6.200,P=0.000),2组术后第3天VAS评分无统计学差异(P=0.933)。结论经肋缘下胸腔镜胸腺扩大切除术不常规留置纵隔引流管安全可行,有利于术后康复。

Objective To investigate the safety and feasibility of postoperative management without mediastinal tube placement for patients undergoing subcostal thoracoscopic extended thymectomy.Methods Between February 2015 and June 2018, 108 patients underwent subcostal thoracoscopic extended thymectomy without major vascular or lung tissue injury.The patients were divided into two groups: the control group consisted of 32 patients who underwent surgery before April 2016 and in whom a mediastinal tube was routinely placed,while the study group consisted of 76 patients who underwent surgery after April 2016 and in whom a mediastinal tube was not placed.The postoperative re-intubation rate,Visual Analogue Scale ( VAS) score and postoperative hospital stay were compared between the two groups.Results Two patients in the study group required closed thoracic drainage after the operation due to pneumothorax.As compared with the control group,the VAS score on the postoperative day 1 was significantly lower [( 2.9 ± 0.8) points vs.( 4.5 ± 0.8) points,t = 9.080,P = 0.000] and the postoperative hospital stay was significantly shorter [( 3.1 ± 0.7) d vs.( 4.0 ± 0.6) d,t = 6.200,P = 0.000]in the study group.There was no significant difference in VAS scores on the postoperative day 3 between the two groups ( P = 0.933).Conclusion Subcostal thoracoscopic extended thymectomy without mediastinal drainage is safe and feasible,and it is beneficial to the early postoperative recovery.