肺癌患者术后胸腔引流管拔除时机及临床效果分析

Analysis of the optimal timing and clinical effect of chest drainage tube removal in patients with lung cancer after surgery

目的:探索肺癌患者术后胸腔引流管的拔除时间与并发症的关系及临床效果.方法:选取2019年1月至2019年6月四川大学华西医院胸外科单个医疗组肺癌切除术患者,纳入研究对象147例,按照患者拔管时间分为A组(术后2~3h拔出引流管,45例)、B组(术后4~6h拔出引流管,54例)和C组(术后12h拔出引流管,48例).分析三组患者术后胸腔闭式引流量、皮下气肿、胸腔积液和积气发生率、胸腔引流管再置管率、术后住院日.结果:三组患者术后均未发生需再次手术的严重并发症.轻度皮下气肿发生率A组(44.44%)显著高于B组(11.11%)和C组(12.50%)(P=0.047).计划拔管成功率A组(57.78%)显著低于B组(96.30%)和C组(100%)(P=0.034);术后再置管率A组(42.22%)显著高于B组(3.70%)和C组(0)(P=0.010),而B组和C组差异无统计学意义(P=0.203).三组患者术后住院日和住院费用[(1.0±0.1)d、(1.4±0.1)d、(1.3±0.2)d];[(42297.3±2401.1)元、(41974.4±3367.1)元、(40445.7±5567.2)元]差异均无统计学意义(P=0.227,P=0.102).结论:肺癌患者术后4~6h拔除胸腔引流管,安全可行,有助于加速患者康复.

Objective:This study explored the relationship between the optimal timing of chest drainage tube removal and the occurrence of complications.Methodsfrom 147 patients(from January to June 2019)who underwent VATS lobectomy or segementectomy of lung cancer,they were randomly divided into group A(postoperative 2-3 h)(45 cases),group B(postoperative 4-6 h)(54 cases)and group C(postoperative 12 h)(48 cases).The postoperative thoracic drainage volume,the incidence of subcutaneous emphysema,chest pleural effusion and pneumatosis,the rate of new drain insertion,the postoperative hospital stay and medical cost were analyzed.Results:^o serious complications requiring reoperation occurred in the three groups after surgery.The incidence of mild subcutaneous emphysema in group A(44.44%)was significandy higher than that in group B(11.11%)and group C(12.50%)(P=0.047).The success rate of planned chest drain removal in group A(57.78%)was significandy lower than that in group B(96.30%)and group C(100%)(P=0.034).The rate of postoperative new drain insertion in group A(42.22%)was significantly higher than that in group B(3.70%)and group C(0),but there was no statistical difference between group B and group G(P=0.010,P=0.203).The length of postoperative stay and the hospitalization cost were[(1.0±ai)d,(1.4±0.1)dand(1.3±02)d],[(42297.3±2401.1)¥,(419744±3367.1)¥,(40445.7±55672)Y]showed no statistical difference(P=0.221,P=OA02).Conclusions:Removal of chest drainage tube 4-6 hours after surgery for lung cancer patients is safe and feasible,which is helpfid to fast recovery.