单孔胸腔镜纵隔良性肿瘤术后免胸管24例临床分析

Clinical Analysis of 24 Patients With Benign Mediastinal Tumor Treated With Uniportal Video-assisted Thoracoscopic Surgery Without Chest Tube Drainage

目的探讨单孔胸腔镜手术(video-assisted thoracoscopic surgery,VATS)治疗纵隔良性肿瘤术后免胸管的可行性。方法2019年2月~2020年9月单孔胸腔镜纵隔良性肿瘤手术44例中,根据肿瘤<6 cm、无侵犯周围组织器官、无包绕大血管或心脏、无严重胸膜腔粘连,选择24例术后不留置胸管引流。结果除1例需胸腔穿刺抽液外,其余患者在围手术期、术后第2周和第4周随访均未出现需要处理的胸腔积液及气胸。术后仅2例需使用止痛药;2例短暂心律失常,无需治疗。切口均一期愈合。结论单孔胸腔镜纵隔良性肿瘤术后免胸管对选择性的部分患者是可行的,符合加速康复外科(enhanced recovery after surgery,ERAS)理念。

Objective To investigate the feasibility of non-chest tube drainage after uniportal video-assisted thoracoscopic surgery(VATS)for benign mediastinal tumor.Methods From February 2019 to September 2020,there were 44 cases who underwent uniportal VATS mediastinal benign tumor surgery.Among the 44 cases,24 were selected not to be placed chest tube for drainage after surgery,according to the tumor size<6 cm,no invasion of surrounding tissues and organs,no wrapping of large blood vessels and heart,and no severe pleural adhesion.Results Except for one case requiring thoracocentesis for fluid extraction,there were no patients with pleural effusion or pneumothorax to be treated during the perioperative period,and at the second and the fourth week of follow-up.Only 2 cases needed painkillers after operation;2 cases with arrhythmia did not require treatment.All incisions were primary healing.Conclusion It is feasible for some selective patients with benign mediastinal tumor treated by uniportal VATS without indwelling chest tube after operation,which is consistent with the concept of enhanced recovery after surgery(ERAS).