单胸管引流位置对肺上叶切除术后胸腔引流的影响  

Effect of single chest tube drainage location on thoracic drainage after pulmonary upper lobectomy

作　　者：李海军[1] 刘家煌 吴齐飞[1] 张广健[1] 付军科[1] LI Haijun;LIU Jiahuang;WU Qifei;ZHANG Guangjian;FU Junke(Department of Thoracic Surgery,First Affiliated Hospital of Xi′an Jiaotong University,Xi′an,Shaanxi 710061,China;Department of General Surgery,First Affiliated Hospital of Xi′an Jiaotong University,Xi′an,Shaanxi 710061,China)

机构地区：[1]西安交通大学第一附属医院胸外科,西安710061 [2]西安交通大学第一附属医院普通外科,西安710061

出　　处：《重庆医学》2021年第8期1377-1380,共4页Chongqing medicine

摘　　要：目的比较胸腔镜肺上叶切除术后单根胸管引流位置的选择对术后胸腔引流效果的影响。方法选择2017年8月至2019年8月于该院行胸腔镜肺上叶切除联合纵隔淋巴结清扫的非小细胞肺癌患者作为研究对象,术中留置单根胸腔引流管并随机分为腋前线组与腋中线组,比较两组患者在术后胸内残腔、术后疼痛评分、术后胸腔引流总量、带管时间、术后住院时间、术后再次置管或穿刺情况、术后胸壁皮下气肿等方面的差异。结果两组患者在性别、年龄、手术部位、病理类型、病理分期、术后胸壁皮下气肿等方面差异均无统计学意义(P>0.05);但在术后胸内残腔、术后疼痛评分、术后胸腔引流总量、带管时间、术后住院时间、术后再次置管或穿刺等方面,两组差异均有统计学意义(P<0.05)。尤其在胸内残腔方面,腋前线组优于腋中线组,经腋前线留置胸腔引流管能显著减少胸内残腔发生,进而减少再次置管或穿刺治疗率。结论胸腔镜肺上叶切除术后于腋前线第4肋间留置单胸管引流安全有效,且有助于减轻患者术后疼痛,减少胸内残腔。Objective To compare the influence of single chest tube drainage location selection on the postoperative thoracic drainage effect after thoracoscopic pulmonary upper lobectomy.Methods The patients with non-small cell lung carcinoma conducting thoracoscopic pulmonary upper lobe resection combined with mediastinal lymph node dissection in the thoracic surgery department of this hospital from August 2017 to August 2019 were selected as the study subjects.The single chest drainage tube was intraoperatively indwelled.The subjects were randomly divided into the anterior axillary line group and mid-axillary line group.The differences in the aspects of postoperative chest residual space,postoperative pain score,total quantity of postoperative thoracic liquid drainage,tube time,postoperative hospital stay,postoperative re-insertion of chest tube or puncture,subcutaneous emphysema of the chest wall were compared between the two groups.Results There was no statistically significant difference between the two groups in terms of the gender,age,surgical site,pathological type,pathological staging,and postoperative chest wall subcutaneous emphysema(P>0.05).Theere were statistically significant differences between the two groups in terms of postoperative chest residual space,postoperative pain score,total liquid quantity of postoperative thoracic drainage,tube time,postoperative hospital stay,re-insertion of chest tube or puncture(P<0.05).Especially in the aspect of intrathoracic residual cavity,the anterior axillary line group was better than the midaxillary group.Indwelling the chest tube through the anterior axillary line could significantly reduce the occurrence of intrathoracic residual cavity,thus reduced the rate of reposition of chest tube or aspiration treatment.Conclusion Indwelling single chest tube drainage in the 4th intercostal space of the anterior axillary line after thoracoscopy pulmonary upper lobectomy is safe and effective,and is conducive to alleviate postoperative pain and residual chest cavity.

关 键 词：癌 非小细胞肺 肺上叶切除 胸腔引流 疼痛评分 

分 类 号：R726.5[医药卫生—儿科]