单孔胸腔镜手术后不留置胸腔引流管在胸部加速康复外科中的应用

Application of uniportal video-assisted thoracoscopic surgery without chest tube in enhanced recovery after thoracic surgery

目的探讨单孔胸腔镜术后不留置胸腔闭式引流管的安全性和可行性。方法回顾性分析内蒙古医科大学附属医院2015年1月至2018年5月行单孔胸腔镜手术治疗肺大疱、肺结节及纵隔肿瘤患者的临床资料,共有78例患者术后不留置胸腔闭式引流管(免管组),其中男30例、女48例,年龄(32.5±8.3)岁;92例患者术后留置胸腔闭式引流管(对照组),其中男38例、女54例,年龄(31.4±13.6)岁。比较两组患者手术相关指标(手术时间、术中出血量、术后早期下床活动时间、切口愈合情况)、术后疼痛评分及术后并发症。结果术后早期下床时间和术后住院时间免管组[(1.0±0.3)d,(3.3±0.7)d,P=0.000]明显低于对照组[(1.8±0.6)d,(5.2±0.8)d,P=0.000],术后第1 d、第2 d、第3 d疼痛视觉模拟评分(VAS)免管组[(4.5±1.8)分,(3.6±2.4)分,(2.5±1.4)分]也明显低于对照组[(6.8±2.2)分,(5.7±2.9)分,(3.9±1.2)分](P=0.000,P=0.000,P=0.000),患者手术时间和术中出血量免管组[(55.3±12.2)min,(21.5±5.1)mL]与对照组[(57.1±6.5)min,(22.2±3.5)mL]差异无统计学意义(P=0.220,P=0.146);两组患者均未发生肺感染,切口愈合率均为100.0%,术后胸腔积气、胸腔积液、心律失常及再次置管方面免管组(5例,8例,1例,3例)与对照组(1例,4例,2例,1例)差异均无统计学意义(P=0.145,P=0.134,P=0.885,P=0.499)。结论在严格筛选的单孔胸腔镜手术患者中,术后不留置胸腔闭式引流管能减轻患者术后疼痛,促进早期下床活动,有利于患者加速康复。

Objective To investigate the clinical feasibility and safety of uniportal video-assisted thoracoscopic surgery(VATS)without chest tube in enhanced recovery thoracic surgery.Method The clinical data of patients with pulmonary bulla,pulmonary nodules and mediastinal tumors who underwent uniportal VATS in Department of Thoracic Surgery in the Affiliated Hospital of Inner Mongolia Medical University between January 2015 to May 2018 were retrospectively analyzed.A total of 78 patients did not receive closed thoracic drainage tube(a tube-free group),including30 males and 48 females aged 32.5±8.3 years,92 patients closed thoracic drainage tube after operation(a control group),including 38 males and 54 females aged 31.4±13.6 years.The surgery-related indicators,postoperative complications and visual analogue score(VAS)were compared between the two groups.Results The time of early ambulation and hospital stay after operation in the tube-free group(1.0±0.3 d,3.3±0.7 d)were significantly shorter than those in the control group(1.8±0.6 d,5.2±0.8 d)(P=0.000,P=0.000).The VAS pain scores on the first,second and third day after operation in the tube-free group(4.5±1.8,3.6±2.4,2.5±1.4)were also significantly lower than those in the control group(6.8±2.2,5.7±2.9,3.9±1.2)(P=0.000,P=0.000,P=0.000).Operation time and intraoperative blood loss in the tube-free group(55.3±12.2 min,21.5±5.1 mL)and the control group(57.1±6.5 min,22.2±3.5 mL)were not statistically different(P=0.220,P=0.146).There was no pulmonary infection in both groups,and the wound healing rate was 100.0%.There was no significant difference in pneumothorax,pleural effusion,arrhythmia and re-insertion of chest drain between the tube-free group(5 patients,8 patients,1 patient,3 patients)and the control group(1 patient,4 patients,2 patients,1 patient,P=0.145,P=0.134,P=0.885,P=0.499).Conclusion In strictly screened patients undergoing uniportal thoracoscopic surgery,no thoracic closed drainage tube can relieve postoperative pain,promote early ambulation activities and enhanced recovery of patients.