胸腔镜全肺切除术后两种胸腔引流方式的临床观察  

Clinical comparison of two thoracic drainage methods after thoracoscopic pneumonectomy

作　　者：陈蓓 丁君蓉 王华 陈健 蒋雷 CHEN Bei;DING Junrong;WANG Hua;CHEN Jian;JIANG Lei(Shanghai Pulmonary Hospital,Tongji University,Shanghai,200433,P.R.China)

机构地区：[1]同济大学附属上海市肺科医院

出　　处：《中国胸心血管外科临床杂志》2019年第11期1088-1091,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的观察开放胸腔引流方式和常规胸腔引流管夹闭方式在胸腔镜全肺切除术后的应用,为全肺切除患者寻找一种安全便捷的引流手段。方法回顾性分析2015年1月至2018年3月我院连续147例行胸腔镜全肺切除术患者的临床资料,其中男128例、女19例。按胸腔引流方式将患者分为胸腔开放引流组(不夹闭组,49例)和常规胸腔引流管夹闭组(夹闭组,98例)。比较两组患者术后并发症发生率、胸腔引流管留置时间、术后3 d引流量、术后住院时间、住院总费用及术后生活质量等。结果不夹闭组术后并发症发生率较夹闭组显著降低(10.20%vs.23.47%,P=0.04),胸腔引流管留置时间比夹闭组长[(5.57±2.36)d vs.(3.22±1.23)d,P<0.001];夹闭组术后3 d引流量相对较少。不夹闭组相对夹闭组术后开始下床活动时间早,胸腔再次穿刺少,再次置管率低(P均<0.001)。同时,不夹闭组比夹闭组术后住院时间短[(6.35±1.87)d vs.(8.37±2.56)d,P<0.001],住院费用低[(5.96±0.73)万元vs.(6.62±0.54)万元,P<0.001]。在术后生活质量方面,不夹闭组术后第1个月和第3个月显著优于夹闭组(P均<0.001)。结论相比于常规胸腔引流管夹闭引流,对患者实施胸腔开放引流的效果更优,有助于减少术后并发症,缩短患者住院时间,降低患者住院费用,提高术后生活质量,值得临床推广。Objective To explore an effective and safe drainage method, by comparing open thoracic drainage and conventional thoracic drainage for lung cancer patients after thoracoscopic pneumonectomy. Methods The clinical data of 147 patients who underwent thoracoscopic pneumonectomy from January 2015 to March 2018 in our hospital were retrospectively analyzed, including 128 males and 19 females. Based on drainage methods, they were divided into an open drainage group(open group) and a conventional drainage group(regular group). The incidence of postoperative complications, chest tube duration, drainage volume at postoperative 3 days, postoperative hospital stay, hospitalization cost and quality of life were compared between the two groups. Results Postoperative complication rate was lower in the open group than that in the regular group(10.20% vs. 23.47%, P=0.04). The chest tube duration of the open group was longer compared with the regular group(5.57±2.36 d vs. 3.22±1.23 d, P<0.001). The drainage volume at postoperative 3 days was less in the regular group. In the open group, ambulation was earlier, thoracocentesis was less and re-intubation rate was lower(all P<0.001). The postoperative hospital stay in the regular group was significantly longer than that in the open group(8.37±2.56 d vs. 6.35±1.87 d, P<0.001) and hospitalization cost was significantly higher(66.2±5.4 thousand yuan vs. 59.6±7.3 thousand yuan, P<0.001). Besides, quality of life in 1 and 3 months after operation was significantly better than that in the open group(P<0.001). Conclusion Compared with the regular chest drainage, the effect of open thoracic drainage is better, which can help reduce postoperative complications, shorten the length of hospital stay, reduce the hospitalization cost and improve the quality of postoperative life. It is worthy of clinical promotion.

关 键 词：全肺切除术 胸腔镜 肺癌 引流 

分 类 号：R47[医药卫生—护理学]