胸腔镜肺癌肺叶切除术后16F较28F胸腔引流管应用的临床优势

What are the Advantages?A Prospective Analysis of 16 versus 28 French Chest Tube Sizes in Video-assisted Thoracoscopic Surgery Lobectomy of Lung Cancer

背景与目的微创胸外科术后管理仍延用开放术后的方式,尤其是胸腔引流管的术后管理,本研究探讨胸腔镜(video-assisted thoracic surgery,VATS)肺叶切除术后应用胸腔引流管(16 F)对切口愈合延迟的影响,是否因引流管管径小而导致相关并发症的增多。方法选取2014年2月-2014年5月四川大学华西医院连续收治的163例肺癌行VATS肺叶切除术,分别应用引流管28 F(75例)和16 F(88例),分析术后胸腔积气、积液、皮下气肿、引流管持续时间、术后住院日、术后引流管拆线时间和切口愈合率。结果平均引流量和心律失常发生率在16 F组[(365±106)m L,14.67%]明显低于28 F组[(665±217)m L,4.5%](P=0.030,1,P=0.047);术后胸腔积气、积液和皮下气肿在28 F组发生率(4.00%,0.0%,7.50%)与16 F组(4.50%,3.41%,6.82%)均无统计学差异(P<0.999,P=0.253,P=0.789);引流管持续时间及术后平均住院日在16F组[(22.1±11.8)h,(4.23±0.05)d]与28 F组[(28.4±16.12)h,(4.57±0.16)d]均无统计学差异(P=0.12,P=0.078);引流管拆线时间在16 F组(7.05±2.11)d明显短于28 F组(14.33±3.87)d(P=0.034);切口一级愈合率在16 F组(95.45%)明显高于28 F组(77.73%)(P=0.039)。结论胸腔镜肺叶切除术后16 F和28 F引流临床效果相当,而16 F有助于引流管口快速愈合。

Background and objective Post-operation management of minimally invasive thoracic surgery is similar to that of open surgery, especially on the drainage tube of the chest. The aim of this study is to compare the advantages of using 16 F versus 28 F chest tubes in video-assisted thoracoscopic surgery(VATS) lobectomy of lung cancer. Methods Data from 163 patients(February-May 2014) who underwent VATS lobectomy of lung cancer with insertion of one chest drain(16 F or 28 F) were analyzed. The following post-operative data were evaluated: primary healing of tube incision, CXR abnormalities(pneumothorax, fluid, atelectasis, subcutaneous emphysema, and hematoma), drainage time, new drain insertion, and wound healing at the site of insertion. Results A total of 75 patients received 28 F chest tubes, and 88 patients received 16 F chest tubes. Both groups were similar in age, gender, comorbidities, and pathological evaluation of resection specimens. After adjustment, no statistically significant difference was found between the two groups in relation to tube-related complications including residual pneumothoraces(4.00% vs 4.44%; P=0.999), subcutaneous emphysema(8.00% vs 6.67%; P=0.789), retained hemothorax(0 vs 41%, P=0.253), and drainage time [(28.4±16.12) h vs(22.1±11.8) h; P=0.120)] The average total drainage volume and rrhythmia rates of the 16 F group [(365±106) m L, 14.67%)] was less than that of the 28 F group [(665±217) m L, 4.5%; P=0.030, P=0.047]. The rates of primary healing at the site of insertion in the 16 F group(95.45%) was higher than that in the 28 F group(77.73%, P=0.039). A significant difference was found on the post-operative length of stay of the two groups [(4.23±0.05) d vs(4.57±0.16) d, P=0.078]. Conclusion The use of 16 F chest tube for VATS lobectomy of patients with lung cancer did not affect the clinically relevant outcomes tested. However, 16 F chest tube facilitated faster wound healing at the site of insertion.