切换至 "中华医学电子期刊资源库"

中华腔镜外科杂志(电子版) ›› 2020, Vol. 13 ›› Issue (06) : 347 -351. doi: 10.3877/cma.j.issn.1674-6899.2020.06.007

所属专题: 文献

论著

早期拔除胸腔引流管在胸腔镜肺部手术后的应用
喻傲1, 焦子宸1, 王涛1,()   
  1. 1. 210008 南京大学医学院附属鼓楼医院心胸外科
  • 收稿日期:2020-06-16 出版日期:2020-12-30
  • 通信作者: 王涛

Application of early removal of chest tube after video-assisted thoracoscopic lung surgery

Ao Yu1, Zichen Jiao1, Tao Wang1,()   

  1. 1. Department of Thoracic and Cardiovascular Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
  • Received:2020-06-16 Published:2020-12-30
  • Corresponding author: Tao Wang
引用本文:

喻傲, 焦子宸, 王涛. 早期拔除胸腔引流管在胸腔镜肺部手术后的应用[J/OL]. 中华腔镜外科杂志(电子版), 2020, 13(06): 347-351.

Ao Yu, Zichen Jiao, Tao Wang. Application of early removal of chest tube after video-assisted thoracoscopic lung surgery[J/OL]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2020, 13(06): 347-351.

目的

探讨胸腔镜肺部手术后早期拔除胸腔引流管的可行性和安全性,探索胸腔引流管的拔除指征。

方法

选择2019年11月至2020年4月在南京大学医学院附属鼓楼医院行胸腔镜肺部手术,并于术后早期(48 h内)拔除胸腔引流管患者117例作为观察组;另外选择2018年11月至2019年4月在南京大学医学院附属鼓楼医院行胸腔镜肺部手术,但术后非早期拔除胸腔引流管患者114例作为对照组。两组在年龄(P=0.476)、性别(P=0.216)、术式(P=0.715)、是否行纵隔淋巴结清扫或采样(P=0.200)、目标肺叶(P=0.925)、病变性质(P=0.957)方面均差异无统计学意义。回顾性分析两组患者术后临床结果、拔除引流管后并发症及再次行胸腔引流情况。

结果

观察组和对照组拔管前24 h引流量[(245.7±98.1)ml比(120.8±46.8)ml,P<0.001]、术后引流时间[(43.9±2.6)h比(84.5±10.5)h,P<0.001]、术后住院时间[(2.2±0.4)d比(4.2±1.1)d,P<0.001]、住院费用[(5.3±0.4)万元比(5.6±0.3)万元,P<0.001]、拔管后疼痛视觉模拟评分(visionl analogue scale, VAS) [(4.4±1.2)分比(3.3±1.2)分,P<0.001]、拔管后总体并发症发生率(20.5%比10.5%,P=0.036)差异有统计学意义,观察组拔管前后VAS [(5.9±0.8)分比(4.4±1.2)分,P<0.001]和对照组拔管前后VAS [(6.0±0.9)分比(3.3±1.2)分,P<0.001]差异有统计学意义。观察组和对照组拔管前VAS [(5.9±0.8)分比(6.0±0.9)分,P=0.464]、拔管后气胸(1.7%比0.9%,P>0.999)、胸腔积液(12.8%比6.1%,P=0.084)、皮下气肿(2.6%比1.8%,P>0.999)、发热(3.4%比1.8%,P=0.703)、再次行胸腔引流(2.6%比1.8%,P>0.999)发生率差异无统计学意义。

结论

虽然术后早期拔除引流管可能会增加拔除引流管后胸腔积液的发生率,但早期拔除引流管可以明显减轻患者术后疼痛,并且不会增加气胸、皮下气肿、发热的发生率,也不会增加再次行胸腔引流的风险。因此,胸腔镜肺部手术后早期拔除胸腔引流管是安全、可行的,有利于减轻患者经济负担,缩短住院时间,促进患者加速康复。

Objective

To explore the feasibility and safety of early removal of chest tube after video-assisted thoracoscopic lung surgery and explore the indication of removal of chest tube.

Methods

117 patients were selected as the observation group who performed video-assisted thoracoscopic lung surgery in the department of cardiothoracic surgery from Nov. 2019 to Apr. 2020, in Drum Tower Hospital, affiliated with Nanjing University Medical School, and removed chest tube after operation early (in 48 hours). 114 patients with routine removal of chest tube were selected as the control group who performed video-assisted thoracoscopic lung surgery in the same hospital from Nov. 2018 to Apr.2019. Age (P=0.476), sex (P=0.216), surgical methods (P=0.715), mediastinal lymph node dissection or sampling (P=0.200), target lobes (P=0.925), pathological nature (P=0.957) were similar between the two groups. This retrospective study analyzed the postoperative clinical results, complications and recurrent pleural drainage after extubation between the two groups.

Results

There were significant differences in the amount of drainage before extubation in 24 hours [(245.7±98.1)ml vs(120.8±46.8)ml, P<0.001], the time of drainage after operation [(43.9±2.6)h vs(84.5±10.5)h, P<0.001], hospitalization time of postoperative [(2.2±0.4)d vs(4.2±1.1)d, P<0.001], hospitalization cost [(53 000±4 000)yuan vs (56 000±3 000)yuan, P<0.001], the VAS score after extubation [(4.4±1.2) vs (3.3±1.2), P<0.001], and incidence of total complications after extubation (20.5% vs 10.5%, P=0.036) between the two groups. The VAS score before and after extubation in the observation group [(5.9±0.8) vs(4.4±1.2), P<0.001]and the VAS score before and after extubation in the control group [(6.0±0.9) vs (3.3±1.2), P<0.001]were statistically significant. The VAS score before extubation [(5.9±0.8) vs(6.0±0.9), P=0.464], the incidence of pneumothorax after extubation (1.7% vs 0.9%, P>0.999), pleural effusion (12.8% vs 6.1%, P=0.084), cutaneous emphysema (2.6% vs 1.8%, P>0.999), fever (3.4% vs 1.8%, P=0.703) and recurrent pleural drainage(2.6% vs 1.8%, P>0.999)were similar between the two groups.

Conclusions

Early removal of chest tube after video-assisted thoracoscopic lung surgery may increase the incidence of pleural effusion after extubation, however, early removal of chest tube can significantly reduce pain after operation, and does not increase the incidence of pneumothorax, cutaneous emphysema, and fever, nor increase the risk of recurrent pleural drainage. Therefore, it is safe and feasible to remove the chest tube early after video-assisted thoracoscopic lung surgery, which is beneficial to reduce the economic burden of patients, shorten the hospitalization days, and enhance recovery after surgery.

表1 两组胸腔镜肺部手术患者的临床基本信息
表2 两组胸腔镜肺部手术患者的术后临床结果比较(±s)
表3 两组胸腔镜肺部手术患者的拔管前后VAS比较(分,±s)
表4 两组胸腔镜肺部手术患者的拔除引流管后并发症比较[例(%)]
表5 两组胸腔镜肺部手术患者的拔除引流管后再次行胸腔引流情况比较[例(%)]
1
刘成武,刘伦旭.肺癌微创外科治疗进展[J/CD].中华胸部外科电子杂志,2016,3(2):65-69.
2
车国卫,刘伦旭,石应康.加速康复外科临床应用现状与思考[J]. 中国胸心血管外科临床杂志,2016,23(3):211-215.
3
刘高远,甄志鹏,李永辉.胸腔镜肺癌根治术后胸腔引流管管理的研究进展[J].中国现代医学杂志,2019,29(12):48-52.
4
Padilla Alarcon J, Penalver Cuesta JC. Experience with lung resection in a fast-track surgery program[J].Arch Bronconeumol, 2013,49(3):89-93.
5
Gorji HM, Nesami BM, Ayyasi M, et al. Comparison of ice packs application and relaxation therapy in pain reduction during chest tube removal following cardiac surgery[J].N Am J Med Sci, 2014,6(1):19-24.
6
Edwards MA, Naunheim KS. Lobectomy by VATS: taking the plunge[J].Chest, 2014,146(2):246-248.
7
Novoa NM, Jimenez MF, Varela G. When to remove a chest tube[J].Thorac Surg Clin, 2017,27(1):41-46.
8
McKenna RJJ, Mahtabifard A, Pickens A, et al. Fast-tracking after video-assisted thoracoscopic surgery lobectomy, segmentectomy, and pneumonectomy[J].Ann Thorac Surg, 2007,84(5):1663-1667.
9
Cerfolio RJ, Bryant AS. Results of a prospective algorithm to remove chest tubes after pulmonary resection with high output[J].J Thorac Cardiovasc Surg, 2008,135(2):269-273.
10
张卫强,刘克强,裴迎新,等. 肺叶切除术后胸腔引流方法的改进对快速康复的影响[J/CD]. 中国医学前沿杂志(电子版),2015,8(7):56-58.
11
焦嘉,杜铭.中心静脉导管在单孔胸腔镜肺叶切除术后快速康复中应用的随机对照研究[J].中国胸心血管外科临床杂志,2019,26(4):358-363.
12
Bjerregaard LS, Jensen K, Petersen RH, et al. Early chest tube removal after video-assisted thoracic surgery lobectomy with serous fluid production up to 500 ml/day[J].Eur J Cardiothorac Surg, 2014,45(2):241-246.
13
Refai M, Brunelli A, Salati M, et al. The impact of chest tube removal on pain and pulmonary function after pulmonary resection[J]. Eur J Cardiothorac Surg, 2012,41(4):820-822.
14
任占良,张泳,任小朋,等. 加速康复理念在单孔胸腔镜肺癌根治术的应用[J/CD]. 中华腔镜外科杂志(电子版),2017,10(6):376-380.
15
张晔,李辉,胡滨,等. 肺叶切除术后早期拔除胸腔引流管的前瞻性随机对照研究[J]. 中华外科杂志,2013,51(6):533-537.
16
马俊杰,高德军. 不同管径胸腔引流管在肺叶切除术后的临床应用比较[J/CD]. 中华胸部外科电子杂志,2016,3(3):156-159.
17
王毅,杨彦辉,罗雷,等. 单孔胸腔镜肺癌根治术后胸腔引流管的选择[J]. 中华肿瘤防治杂志,2017,24(18):1310-1314.
18
杨梅,樊骏,周红霞,等. 胸腔镜肺癌肺叶切除术后16 F较28 F胸腔引流管应用的临床优势[J]. 中国肺癌杂志,2015,8(8):512-517.
19
Nadlonek NA, Acker SN, Deterding RR, et al. Intraoperative chest tube removal following thoracoscopic lung biopsy results in improved outcomes[J]. J Pediatr Surg, 2014,49(11):1573-1576.
[1] 陆婷, 姜巧玲, 孙黎, 王雪静. 加速康复外科在肾移植围手术期应用的研究进展[J/OL]. 中华移植杂志(电子版), 2024, 18(01): 55-59.
[2] 许桂祥, 吴海华, 赵鸿志, 徐丽, 胡晓萍, 周世龙, 武永明, 彭新刚. 后鞘前入路腹腔镜视野下腹股沟区脂肪归属的解剖要点及临床意义[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(03): 277-281.
[3] 成紫琳, 戴明, 李建华, 马靓. 加速康复外科理念在儿童腹股沟疝围手术期的应用[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(03): 331-335.
[4] 王招荐, 曹桢, 郭小双, 靳小雷, 刘子文. 加速康复外科理念应用于腹壁重建手术的系统评价及Meta分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(03): 343-350.
[5] 郑华蓉, 刘俊, 郑艳, 陈玉莲, 廖子敏. 加速康复外科理念下的集束化护理模式在腹股沟疝修补术中的应用效果[J/OL]. 中华疝和腹壁外科杂志(电子版), 2023, 17(05): 643-646.
[6] 许喜乐, 徐敏. 达芬奇机器人辅助肺段切除术治疗ⅠA期NSCLC的临床疗效分析[J/OL]. 中华肺部疾病杂志(电子版), 2023, 16(05): 658-660.
[7] 贾雪敏, 刘海元. 加速康复外科在卵巢囊肿患者围术期的应用[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(01): 36-38.
[8] 冯嘉楠, 蔡磊, 何国林, 付顺军, 张成, 冯周彬, 温耀鸿, 谭洪坤, 潘明新. 腹腔镜胆总管切开探查取石一期缝合的安全性与疗效:附128例分析[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(04): 543-550.
[9] 朱志, 张鑫炜, 谭文斐, 高梓茗, 赵睿涵, 杨野, 王世洋, 智冬梅, 赵鑫, 尹长欣, 高畅远, 王锡山, 王振宁, 李凯, 周海涛. 直肠癌经自然腔道取标本手术在日间手术中的应用[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(04): 329-334.
[10] 李凯, 朱志, 周海涛, 王俊, 杨野, 赵鑫, 谷金蓉, 智冬梅, 王世洋, 高梓茗, 张鑫炜, 赵睿涵, 王锡山, 王振宁. 经自然腔道取标本手术(NOSES)在结直肠癌日间手术中的应用探索[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(01): 63-67.
[11] 中华医学会骨科分会关节学组. 中国髋、膝关节置换日间手术围手术期管理专家共识[J/OL]. 中华老年骨科与康复电子杂志, 2023, 09(06): 321-332.
[12] 王嘉巍, 张广健, 杜昊楠, 余宸傲, 张佳. 混合现实技术在肺结节手术中的应用进展[J/OL]. 中华胸部外科电子杂志, 2024, 11(04): 254-259.
[13] 莫安胜, 王国正, 宾能康, 郑昌泽. 剑突下入路胸腔镜纵隔手术技术及其进展[J/OL]. 中华胸部外科电子杂志, 2024, 11(02): 130-142.
[14] 陆志斌, 王黎, 何思东, 周存荣, 潘春峰. 肺淋巴管肌瘤病伴气胸胸腔镜手术治疗1例及文献复习[J/OL]. 中华胸部外科电子杂志, 2024, 11(01): 67-70.
[15] 马建惠, 韩琦, 李韶玲. 加速康复外科护理路径+量化评估对腹腔镜胆囊切除术高龄患者手术室护理满意度的影响[J/OL]. 中华胃食管反流病电子杂志, 2024, 11(01): 53-56.
阅读次数
全文


摘要