超细引流管联合肋间神经阻滞在非小细胞肺癌手术中的应用

Application of Superfine Drainage Tube Combined With Intercostal Nerve Block in Surgery for Non-small Cell lung Cancer

目的探讨超细引流管联合肋间神经阻滞在非小细胞肺癌手术中的应用价值。方法回顾性分析兰州大学第一医院2016年1月~2018年12月单孔胸腔镜肺叶切除术治疗非小细胞肺癌100例的临床资料,其中术后放置8Fr超细引流管并行超声引导下肋间神经阻滞46例(观察组),使用常规32Fr引流管并手术切口罗哌卡因局部浸润54例(对照组),比较2组术后疼痛及引流时间等指标。结果与对照组相比,观察组术后1、2、3天疼痛评分更低[(4.7±0.9)分vs.(6.0±1.2)分,t=-6.169,P=0.000;(3.0±0.6)分vs.(3.3±0.9)分,t=-2.482,P=0.015;(1.9±0.6)分vs.(2.8±0.5)分,t=-8.499,P=0.000],术后镇痛次数更少[(2.0±0.7)次vs.(3.1±0.6)次,t=-9.035,P=0.000],引流管放置时间更短[(3.6±0.7)d vs.(4.0±0.6)d,t=-3.238,P=0.002],术后住院时间更短[(5.1±0.6)d vs.(5.6±1.1)d,t=-2.781,P=0.007],肺部感染发生率更低[10.9%(5/46)vs.27.8%(15/54),χ^2=4.438,P=0.035],但2组术后总引流量、胸腔积液及切口延迟愈合发生率差异均无统计学意义(P>0.05)。结论超细管引流联合肋间神经阻滞在非小细胞肺癌术后可以达到快速康复的目的,符合加速康复外科理念。

Objective To investigate the application of superfine drainage tube combined with intercostal nerve block in the operation for non-small cell lung cancer(NSCLC)based on the concept of enhanced recovery after surgery(ERAS).Methods The study retrospectively evaluated 100 patients with NSCLC who received lobectomy with uniportal video-assisted thoracoscope(VATS)in our hospital between January 2016 and December 2018.Of those patients,46 patients underwent the postoperative intercostal nerve block under ultrasound guidance with 8Fr superfine drainage tubes indwelling postoperatively(observation group),while conventional 32Fr drainage tubes were used with local ropivacaine incision infiltration in 54 patients(control group).The postoperative pain and drainage data were compared between the two groups.Results Compared to control group,the observation group had lower pain scores on postoperative 1 st,2 nd,and 3 rd days[(4.7±0.9)points vs.(6.0±1.2)points,t=-6.169,P=0.000;(3.0±0.6)points vs.(3.3±0.9)points,t=-2.482,P=0.015;(1.9±0.6)points vs.(2.8±0.5)points,t=-8.499,P=0.000],fewer postoperative frequency for analgesia[(2.0±0.7)times vs.(3.1±0.6)times,t=-9.035,P=0.000],shorter drainage time[(3.6±0.7)d vs.(4.0±0.6)d,t=-3.238,P=0.002],shorter postoperative inpatient stay[(5.1±0.6)d vs.(5.6±1.1)d,t=-2.781,P=0.007],and lower pulmonary infection rate[10.9%(5/46)vs.27.8%(15/54),χ^2=4.438,P=0.035].However,there were no significant differences in postoperative total drainage,incidence of postoperative hydrothorax and delayed wound healing(P>0.05).Conclusion Superfine drainage tube combined with intercostal nerve block can achieve enhanced recovery after surgery,which is worthy of clinical application.