3种引流方式在单孔胸腔镜Ⅰ期肺癌手术患者术后胸腔引流中的应用

Application of three drainage methods in thoracic drainage after single-port thoracoscopic surgery for lung cancer at phase Ⅰ

目的观察3种引流方式在单孔胸腔镜Ⅰ期肺癌手术患者术后胸腔引流中的应用效果。方法选取105例单孔胸腔镜Ⅰ期肺癌手术患者,按照引流方式的不同分为研究组(胸腔引流管联合猪尾巴导管)、对照1组(胸腔引流管联合深静脉穿刺管)、对照2组(胸腔引流管),每组35例。比较3组术后引流情况、恢复指标、术后疼痛视觉模拟评分法(VAS)评分、镇痛泵自控按压次数、不良事件及术后3个月并发症。结果研究组术后引流总量多于对照1组和对照2组,对照1组多于对照2组,差异均有统计学意义(P<0.05)。出院时以及术后3个月时,研究组胸腔内残留积液量均少于对照1组和对照2组,且对照1组少于对照2组,差异均有统计学意义(P<0.05)。研究组引流管留置时间、住院时间短于对照1组和对照2组,差异有统计学意义(P<0.05)。3组切口拆线时间,切口1级愈合率,术后24、48 h的VAS评分,镇痛泵自控按压次数,住院期间脱管、气胸、血胸、肺不张发生率以及术后3个月气胸发生率比较,差异无统计学意义(P>0.05)。研究组堵管发生率为2.86%,低于对照1组的22.86%,差异有统计学意义(P<0.05)。结论与胸腔引流管、胸腔引流管联合深静脉穿刺管相比,胸腔引流管联合猪尾巴导管可有效增加单孔胸腔镜Ⅰ期肺癌手术患者术后胸腔引流量,提高引流效率,缩短引流管留置时间,降低堵管发生风险。

Objective To observe the application effect of three drainage methods in thoracic drainage after single-port thoracoscopic surgery for lung cancer at phaseⅠ.Methods A total of 105 patients with single-port thoracoscopic surgery for lung cancer at phaseⅠwere selected and divided into study group(treated with thoracic drainage tube and pigtail catheter),control group 1(treated with thoracic drainage tube and deep vein catheter)and control group 2(treated with thoracic drainage tube)according to the drainage method,with 35 cases in each group.Postoperative drainage situation,recovery indicators,score of the Visual Analogue Scale(VAS)for pain after operation,pressing times of patient-controlled analgesic pump,adverse events and complications 3 months after surgery were compared among the three groups.Results The total postoperative drainage volume in the study group was significantly more than that in the control group 1 and control group 2,and the volume in the control group 1 was also significantly more than that in the control group 2(P<0.05).At discharge and 3 months after surgery,the volume of residual pleural effusion in the study group was significantly lower than those in the control group 1 and the control group 2,and the volume in the control group 1 was also significantly lower than that in the control group 2(P<0.05).The indwelling time of drainage tube and hospital stay in the study group were significantly shorter than those in the control group 1 and the control group 2(P<0.05).There were no significant differences in thread removal time of incision,level 1 healing rate of incision,VAS scores at 24 and 48 hours after operation,pressing times of patient-controlled analgesic pump,incidence rates of extubation,pneumothorax,hemothorax and atelectasis during hospitalization,and incidence of pneumothorax at 3 months after surgery among the three groups(P>0.05).The incidence of tube blockage in the study group was 2.86%,which was significantly lower than 22.86%in the control group 1(P<0.05).Conclusion Compared with thoracic drainage tube alone and thoracic drainage tube combined with deep vein catheter,thoracic drainage tube combined with pigtail catheter can effectively increase postoperative thoracic drainage volume in patients with single-port thoracoscopic surgery for lung cancer at phaseⅠ,improve drainage efficiency,shorten indwelling time of drainage tube,and reduce the risk of tube blockage.