中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

单孔胸腔镜手术后不留置胸腔引流管在胸部加速康复外科中的应用

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目的 探讨单孔胸腔镜术后不留置胸腔闭式引流管的安全性和可行性。 方法 回顾性分析内蒙古医科大学附属医院 2015 年 1 月至 2018 年 5 月行单孔胸腔镜手术治疗肺大疱、肺结节及纵隔肿瘤患者的临床资料,共有 78 例患者术后不留置胸腔闭式引流管(免管组),92 例术后留置胸腔闭式引流管(对照组),比较两组患者手术相关指标(手术时间、术中出血量、术后早期下床活动时间、切口愈合情况)、术后疼痛评分及术后并发症。 结果 术后早期下床时间和术后住院时间免管组[(1.0±0.3)d,(3.3±0.7)d]明显低于对照组[(1.8±0.6)d,(5.2±0.8)d](P=0.000,P=0.000),术后第 1 d、第 2 d、第 3 d 视觉模拟评份(VAS)疼痛评分免管组[(4.5±1.8)分,(3.6±2.4)分,(2.5±1.4)分]也明显低于对照组[(6.8±2.2)分,(5.7±2.9)分,(3.9±1.2)分](P=0.000,P=0.000,P=0.000),患者手术时间和术中出血量免管组[(55.3±12.2)min,(21.5±5.1)ml]与对照组[(57.1±6.5)min,(22.2±3.5)ml]差异无统计学意义(P=0.22,P=0.146);两组患者均未发生肺感染,切口愈合率均为 100.0%,术后胸腔积气、胸腔积液、心律失常及再次置管方面免管组(5 例,8 例,1 例,3 例)与对照组(1 例,4 例,2 例,1 例)差异均无统计学意义(P=0.145,P=0.134,P=0.885,P=0.499)。 结论 在严格筛选的单孔胸腔镜手术患者中,术后不留置胸腔闭式引流管能减轻患者术后疼痛,促进早期下床活动,有利于患者加速康复。

Objective To investigate the clinical feasibility and safety of uniportal VATS without chest tube in enhanced recovery thoracic surgery. Method The clinical data of patients with Pulmonary bulla, Pulmonary nodules and mediastinal tumors who underwent uniportal VATS in thoracic surgery in the Affiliated Hospital of Inner Mongolia Medical University between January 2015 to May 2018 were retrospectively analyzed. A total of 78 patients did not closed thoracic drainage tube (tube-free group), 92 patients closed thoracic drainage tube after operation (control group).The surgery-related indicators, postoperative complications and VAS pain scores were compared between two groups. Results The time of early ambulation and hospital stay after operation in the tube-free group (1.0+0.3 d, 3.3+0.7 d) were significantly lower than those in the control group (1.8+0.6 d, 5.2+0.8 d) (P=0.000, P=0.000). The VAS pain score in the tube-free group (4.5+1.8 scores, 3.6+2.4 scores, 2.5+1.4 scores) on the first, second and third day after operation was also significantly lower than those in the control group (6.8±2.2 scores, 5.7±2.9 scores, 3.9±1.2 scores, P=0.000, P=0.000, P=0.000), operation time and intraoperative blood loss in the tube-free group (55.3+12.2 min, 21.5+5.1 ml) and the control group (57.1+6.5 min, 22.2+3.5 ml) had no statistical difference (P=0.22, P=0.146). There was no pulmonary infection in both groups, and the wound healing rate was 100.0%. There was no significant difference in pneumothorax, pleural effusion, arrhythmia and re-insertion of chest drain between the tube-free group (5 patients, 8 patients, 1 patient, 3 patients) and the control group (1 patient, 4 patients, 2 patients, 1 patient, P=0.145, P=0.134, P=0.885, P=0.499). Conclusion In strictly screened patients undergoing uniportal thoracoscopic surgery, no thoracic closed drainage tube can relieve postoperative pain, promote early ambulation activities and enhanced recovery of patients.

关键词: 单孔胸腔镜; 胸腔闭式引流; 快速康复;  

Key words: Uniportal; video-assisted thoracoscopic surgery; chest drainage; enhanced recovery after surgery

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