电视胸腔镜肺叶切除术细管辅助胸腔闭式引流疗效分析  

Effect of thoracic close drainage assisted by thin chest tube after video-assisted thoracic surgery lobecto-my

作　　者：范开杰[1] 刘阳[1] 杨博[1] 戴为民[1] 林吉兴 初向阳[1] 

机构地区：[1]解放军总医院胸外科,北京100853

出　　处：《国际肿瘤学杂志》2015年第4期245-248,共4页Journal of International Oncology

摘　　要：目的：研究电视胸腔镜（VATS）肺叶切除术后细管辅助粗管胸腔闭式引流置管方式的疗效。方法回顾性分析2014年1月至2014年9月在解放军总医院胸外科接受 VATS 肺叶切除术的89例非小细胞肺癌患者，实验组50例采用细引流管辅助粗引流管胸腔闭式引流术，对照组39例采用常规改良胸腔闭式引流管。观察统计两组患者手术时长、术中出血量、清扫淋巴结数目、下床时间、术后住院时间、术后并发症、术后引流天数、引流量、引流效果，术后疼痛采用视觉模拟评分法（ VAS）。结果实验组和对照组的手术时长[（2.58±0.57）h ：（2.57±0.50）h，t =0.127，P =0.681]、术中出血[（108.00±52.84）ml ：（114.10±107.18）ml，t =0.352，P =0.334]、淋巴结清扫数目[（14.20±5.95）枚：（11.21±4.71）枚，t =2.576，P =0.068]、引流管留置时长[（5.66±2.53）d ：（5.82±2.02）d，t =0.324，P =0.219]、总引流量[（1141.76±819.26）ml ：（1022.95±464.84）ml，t =0.889，P =0.367]及术后并发症发生率（8.00%：10.25%，χ2=1.750，P =0.726）差异均无统计学意义。两组术后下床活动时间[（11.28±8.78）h ：（13.97±7.83）h，t =4.027，P =0.045]、术后住院天数[（8.36±2.63）d ：（9.56±2.89）d，t =2.952，P =0.043]、引流效果（72.0%：46.2%，χ2=5.329，P =0.017）差异有统计学意义。两组患者术后24~72 h 静息及咳痰时 VAS 疼痛评分差异有统计学意义，分别为24 h[（2.78±1.13）：（3.74±1.68），t =3.226，P＜0.001]，48 h[（1.98±0.59）：（3.33±1.72），t =5.189，P ＜0.001]，72 h[（1.94±0.55）：（3.15±1.60），t =5.010，P ＜0.001]，咳嗽时[（3.64±1.23）：（5.33±1.95），t =5.005，P ＜0.001]。结论 VATS 肺叶切除术后细引流管辅助胸腔闭式引流更有效，能减少患者术后痛苦，缩短住院时间，且操作简单，安全性高，易于推广，具有较高的改良价值。Objective To evaluate the clinical effects of thoracic close drainage with thin drainage tube assisted to thick drainage tube after video-assisted thoracic surgery（VATS）lobectomy. Methods We ret-rospectively reviewed 89 patients received VATS lobectomy in Chinese PLA General Hospital from January 2014 to September 2014. The patients with non-small cell lung cancer were divided into two groups：treatment group （50 patients）and control group（39 patients）. Treatment group took thin tube assisted to thick tube of thoracic close drainage and control group took general thoracic closed drainage tube. We studied the operation time,the bleeding of operation,the number of lymph node dissection,time of first activity out of bed,the hospitalization time of post-operation,post-operative complications,the days of post-operative drainage,drainage volume,the effect of drainage,the VAS evaluation score of post-operative pain in the two groups. Results Compared with control group,there was no statistical significance in the differences of the time of operation[（2. 58 ± 0. 57）h vs（2. 57 ± 0. 50）h;t = 0. 127,P = 0. 681],bleeding of operation[（108. 00 ± 52. 84）ml vs（114. 10 ± 107. 18）ml;t = 0. 352,P = 0. 334],the number of lymph node dissection[（14. 20 ± 5. 95）vs（11. 21 ± 4. 71）;t = 2. 576,P = 0. 068）],the staying time of drainage[（5. 66 ± 2. 53）d vs（5. 82 ± 2. 02）d;t =0. 324,P = 0. 219],the postoperative drainage volume[（1 141. 76 ± 819. 26）ml vs（1 022. 95 ± 464. 84） ml;t = 0. 889,P = 0. 367]and the occurrences of the post-operative complications（8. 00% vs 10. 25% ;χ2 =1. 750,P = 0. 726）. There was statistical significance in the differences of the post-operative time of off-bed [（11. 28 ± 8. 78）h vs（13. 97 ± 7. 83）h;t = 4. 027,P = 0. 045],the time from surgery to discharge [（8. 36 ± 2. 63）d vs（9. 56 ± 2. 89）d;t = 2. 952,P = 0. 043]and the drainage effect（costophrenic angle sharp：72. 0% vs 46. 2% ;χ2 = 5. 329,P = 0. 017）. In the two grou

关 键 词：胸管 引流术 胸腔积液 胸腔镜检查 肺切除术 

分 类 号：R734.2[医药卫生—肿瘤]