胸腔镜肺部手术后应用19F胸管引流的前瞻性队列研究

19F thoracic duct drainage after thoracoscopic pulmonary surgery:a prospective cohort study

目的探讨19F胸管在胸腔镜肺部手术后的引流效果及其与28F胸管比较具有的优势。方法选取2018年8月至2019年8月在该院胸外科择期行胸腔镜肺部手术的患者134例,分别应用19F胸管(19F组,n=53)和28F胸管(28F组,n=81)行胸腔引流,分析术后胸腔引流量、胸腔积气、胸腔积液、皮下气肿、带管时间、疼痛评分、引流口愈合情况、再次置管率、肺部感染情况。结果19F组术后72 h胸腔引流量少于28F组,差异有统计学意义[(510.2±149.1)mL vs.(641.5±247.5)mL,P=0.01]。两组术后肺漏气发生率差异无统计学意义(41.5%vs.50.6%,P=0.302)。19F组皮下气肿发生率显著高于28F组(41.5%vs.24.7%,P=0.04),亚组分析显示肺漏气病例中19F组皮下气肿发生率显著高于28F组(54.5%vs.24.8%,P=0.029),无漏气病例中两组皮下气肿发生率差异无统计学意义(32.3%vs.22.5%,P=0.357)。两组胸腔积气(>10%)、胸腔积液、肺部感染发生率差异无统计学意义(35.8%vs.29.6%,P=0.451;3.8%vs.2.5%,P=0.664;5.7%vs.4.9%,P=0.854)。19F组带管时间短于28F组,差异有统计学意义[(4.56±1.54)d vs.(5.59±2.38)d,P=0.006]。19F组切口愈合不良发生率低于28F组,差异有统计学意义(18.9%vs.38.3%,P=0.017)。logistic多因素分析显示:带管时间大于7 d(OR=4.400,P=0.005)、使用28F引流管(OR=3.912,P=0.003)是引流口愈合不良的独立危险因子。结论胸腔镜肺部手术后应用19F胸管引流安全、有效,有利于缩短带管时间,促进引流口愈合。

Objective To investigate the drainage effect of 19F thoracic duct drainage after thoracoscopic pulmonary surgery and its advantages compared with 28F thoracic duct drainage Methods A total of 134 patients in charged from August 2018 to August 2019 with thoracoscopic lung surgery were selected.The patients were divided into two groups including the 19F group(group 19F,n=53)and the 28F group(group 28F,n=81).The postoperative drainage volume,pneumothorax,pleural effusion,subcutaneous emphysema,catheter duration,pain score,healing of incision,re-catheterization rate,and pulmonary infection were analyzed.Results The average drainage volume of 72 h after operation in group 19F was less than that in group 28F[(510.2±149.1)mL vs.(641.5±247.5)mL,P=0.01].No significant difference in pulmonary air leakage between the two groups(41.5%and 50.6%,P=0.302).The subcutaneous emphysema in group 19F was higher than that in group 28F(41.5%vs.24.7%,P=0.04).Subgroup analysis showed that the subcutaneous emphysema in group 19F was significantly higher than that in group 28F in air leak cases(54.5%vs.24.8%,P=0.029),no statistically significant difference was found between the two group in cases without air leak(32.3%vs.22.5%,P=0.357).No significant difference was found between the two groups in pneumothorax(>10%),pneumothorax,pleural effusion,re-catheterization rate(35.8%vs.29.6%,P=0.451;3.8%vs.2.5%,P=0.664;5.7%vs.4.9%,P=0.854).The catheter duration of 19F group was shorter thanthat of 28F group[(4.56±1.54)d vs.(5.59±2.38)d,P=0.006].The poor incision healing in group 19F was less than that in group 28F(18.9%vs.38.3%,P=0.017).Logistic multivariate analysis revealed that catheter duration over 7 d(OR=4.400,P=0.005)and 28F chest tube(OR=3.912,P=0.003)were independent risk factors for poor incision healing.Conclusion 19F thoracic duct drainage after thoracoscopic pulmonary surgery is safe and effective,with the advantages in shorting catheter duration and promoting incision healing.