单孔胸腔镜肺楔形切除术后留置细管与传统引流方式的比较  

Comparison of small-sized tube drainage and traditional drainage after uniportal thoracoscopic lung wedge-resection

作　　者：田周俊逸 肖飞[1] 冯宏响[1] 张真榕[1] 温焕舜[1] 张瑾[1] 梁朝阳[1] Tian Zhoujunyi;Xiao Fei;Feng Hongxiang;Zhang Zhenrong;Wen Huanshun;Zhang Jin;Liang Chaoyang(Department of Thoracic Surgery,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]中日友好医院胸外科,北京100029

出　　处：《中华胸心血管外科杂志》2024年第6期369-373,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：国家重点研发计划(2022YFC2407302);中日友好医院高水平医院临床业务费专项临床研究(2022-NHLHCRF-YS-04)。

摘　　要：目的比较单孔胸腔镜肺楔形切除术后留置细管引流与传统引流方式的优劣性。方法回顾性分析单中心接受单孔胸腔镜肺楔形切除术的患者。比较留置传统的28Fr胸腔引流管与留置细管患者的临床特点和术后相关结果,利用倾向评分匹配平衡两组基线数据差异。结果入组的178例患者中,传统胸腔团式引流管(A)组121例,细管(B)组57例。倾向评分匹配后共36对患者纳入比较。B组较A组手术时间更短[0.83(0.75,1.04)h对1.08(0.96,1.41)h,P=0.003],出血量更少[5(5,10)ml对10(7.5,10)ml,P=0.001],术后胸腔引流量更少[67.5(30,190)ml对175(120,365)ml,P<0.001];术后疼痛评分更低[0.3(0.3,0.7)对0.7(0.3,2.2),P<0.05]。两组间拔管前少量胸腔积气或拔管前少量胸腔积液发生率差异无统计学意义。两组间术后并发症发生率差异无统计学意义。结论与传统胸腔引流管相比,对单孔胸腔镜肺楔形切除患者应用细管进行术后引流可能是一种减轻患者术后疼痛和促进恢复的可行方法。Objective To assess the merits and demerits of placing small-sized tube as drainage compared with traditional drainage in patients after uniportal thoracoscopic lung wedge-resection.Methods Patients who received uniportal video-assisted thoracoscopic surgery(U-VATS)lung wedge-resection were identified in our database.Patients placed small-sized tube drainage were compared with those placed traditional 28 Fr chest tube in terms of characteristics,perioperative outcomes.Propensity score matching was performed to balance the baseline of the patients.Results Of the 178 enrolled patients,121 were assigned to conventional tube group and 57 were assigned to small-sized tube group.After matching,36 pairs of patients from the two groups were selected for statistical comparison.Compared with the traditional drainage group,the operation duration of the small-sized tube group was shorter[0.83(0.75,1.04)h vs.1.08(0.96,1.41)h,P=0.003],intraoperative blood loss was less[5(5,10)ml vs.10(7.5,10)ml,P=0.001],postoperative total drainage volume was less[67.5(30,190)ml vs.175(120,365)ml,P<0.001],and postoperative pain score was lower[0.3(0.3,0.7)vs.0.7(0.3,2.2),P<0.05].No significant difference was observed in the incidence of small amount of pneumothorax or small amount of pleural effusion before extubation between the two groups.The incidence of postoperative complications was relatively low and there was no significant difference between the two groups.Conclusion Compared to conventional chest tube,small-sized tube for postoperative drainage after U-VATS lung wedge-resection,may be a feasible and promising approach to reduce postoperative pain and promote recovery.

关 键 词：单孔胸腔镜 肺切除 小口径胸引管 术后疼痛 

分 类 号：R655.3[医药卫生—外科学]