引流方式的选择对肺下叶癌根治术后胸腔引流的影响

Effect of different drainage modes on postoperative thoracic drainage after videoassisted thoracoscopic surgery for radical resection of lower lung carcinoma

目的比较单操作孔胸腔镜肺下叶癌根治术后不同的胸腔引流方式对术后胸腔引流效果的影响。方法纳入2017年8月至2019年8月非小细胞肺癌患者共183例,其中男113例、女70例,年龄31~77(56.5±6.4)岁,由同一组术者完成单操作孔胸腔镜下解剖性肺下叶切除联合纵隔淋巴结清扫术,术中留置胸腔引流管并随机分为腋前组、腋中组、腋前改进组,比较三组临床效果。结果三组患者在性别、年龄、手术部位、病理类型、病理分期、术后胸壁皮下气肿、术后疼痛评分、术后住院时间等方面差异均无统计学意义(P>0.05);但在术后胸腔积液、胸腔积液再次治疗、胸腔引流液总量、粗管引流时间、胸壁切口拆线时间等方面,各组间差异有统计学意义(P<0.05)。尤其对于术后胸腔积液,腋前组胸腔引流不彻底风险增加,腋前改进组能显著减少术后胸腔积液的发生(P<0.05),从而降低因积液量大而需再次治疗的发生率(P<0.05)。结论胸腔镜下肺下叶癌根治术后于腋前线第5肋间留置粗引流管(24F)联合于肩胛下角线第7或8肋间留置细引流管(8.5F)可减少术后胸腔积液的发生,缩短粗管引流时间以减轻术后疼痛,缩短胸壁手术切口的拆线时间。

Objective To analyze the effect of different drainage modes on the postoperative thoracic drainage after video-assisted thoracoscopic surgery for radical resection of lower lung carcinoma.Methods A total of 183 patients with non-small cell lung cancer who received biportal thoracoscopic anatomical lower lobectomy combined with mediastinal lymph node dissection in the First Affiliated Hospital of Xi'an Jiaotong University from August 2017 to August 2019 were enrolled,including 113 males and 70 females,aged 31-77(56.5±6.4)years.The patients were randomly divided into three groups,including an anterior axillary line group,a mid-axillary line group and a modified anterior axillary line group.Clinical efficacy of the three groups was compared.Results No significant difference among these three groups in terms of gender,age,surgical site,pathological type,pathological staging,postoperative chest wall subcutaneous emphysema,postoperative pain score,and postoperative hospital stay was found(P>0.05).There were significant differences among the patients in terms of postoperative pleural effusion,re-insertion of chest tube or aspiration,total liquid quantity of thoracic drainage,drainage time and chest wall incision stitches time(P<0.05).The anterior axillary line group had higher risk of postoperative pleural effusion than the other groups(P<0.05).The occurrence of postoperative pleural effusion and rate of reposition of chest tube or aspiration were significantly reduced in the modified anterior axillary line group(P<0.05).Conclusion Chest drainage tube with large diameter(24F)in the 5th intercostal space of the anterior axillary line combined with another micro-tube(8.5F)in the 7th or 8th intercostal space of the inferior scapular angle line can shorten drainage time to reduce postoperative pain,reduce the occurrence of postoperative pleural effusion,and shorten the time of surgical incision stitches.