中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

肺癌、食管癌切除术后胸腔闭式引流拔管时机的前瞻性随机对照研究

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目的探讨肺癌、食管癌术后胸腔引流拔管时机。方法采用前瞻、随机、对照研究方法。2014 年 6 月至 2016 年 2 月我们单医疗组拟诊为肺癌或食管癌行肿瘤切除加纵隔淋巴结清扫 150 例,术前采用 SPSS 17.0 统计软件中产生的随机号分为 3 组(Ⅰ、Ⅱ 和 Ⅲ 组),每组 50 例。Ⅰ、Ⅱ、Ⅲ 组术后胸腔引流量分别为≤100 m/d、101~200 ml/d、201~300 ml/d 拔管。拔管后 48 h 复查胸部 X 线片。结果150 例中排除 23 例(术中病理良性 20 例,术后合并脓胸 2 例,乳糜胸 1 例),纳入 127 例,其中男 108 例、女 19 例,年龄 40~79(59.0±8.7)岁。Ⅰ、Ⅱ、Ⅲ 组分别 45 例、41 例、41 例。除是否采用胸(腹)腔镜手术外,3 组间年龄、性别、肿瘤类型、合并症差异无统计学意义(P>0.05)。本组无死亡,术后并发症 6 例,3 组间差异无统计学意义(P>0.05)。Ⅰ、Ⅱ、Ⅲ 组术后平均留管时间分别(181.0±68.2)h、(111.0±63.1)h、(76.0±37.2)h,平均胸腔引流量为(1 005.0±686.4)ml、(776.0±505.8)ml,拔管后平均住院时间(19.0±9.7)d、(14.0±8.0)d、(9.0±4.8)d,3 组之间差异均有统计学意义(P=0.000)。拔管后因胸腔积液复发需胸膜腔穿刺术或重置小导管引流 13 例,3 组之间差异无统计学意义(P>0.05)。拔管后所有患者胸痛明显减轻。结论肺癌、食管癌术后胸腔引流量≤300 m/d 拔除胸腔引流管,能缩短术后住院时间,加速患者早日康复。

ObjectiveTo evaluate the timing of chest tube removal after resection of lung or esophageal cancer.MethodsA prospective randomized controlled study was performed. From June 2014 to February 2016, 150 patients suspected as the cancer of lung or esophagus undergoing neoplasm resection and lymph node dissection in our single medical unit were classified into 3 groups according to the random number generated by SPSS17.0 with 50 patients in the each group. The drainage volume for chest tube removal was ≤100 m/d in group Ⅰ, 101–200 ml/d in the group Ⅱ, and 201–300 ml/d in the group Ⅲ. Chest radiography was performed 48 hours following chest tube removal. Demographic and perioperative variables including postoperative complications, chest tube duration, drainage output, visual analogous scores, incidence of requiring reintervention due to pleural effusion accumulation and length of postoperative hospital stay were compared among the three groups.ResultsThe 127 patients (108 males and 19 females, with an average age of 59.0±8.7 years) eligible for analysis consisted of 45 patients in the group Ⅰ, 41 in the group Ⅱ, and 41 in the group Ⅲ respectively after the 23 patients were excluded from this study who were diagnosed as benign lesions through intraoperative frozen pathology (n=20) and postoperative complications (empyema in 2 patients and chylothorax in 1 patient). Age, sex, types of neoplasm, and comorbidities but procedures via video-assistated thoracic surgery (and laparoscopy) showed no significant differences among the three groups (P>0.05). No mortality was observed in this study. There were postoperative complications in 6 patients and its distribution had no statistically differences among the groups (P>0.05). The mean postoperative duration of chest tube was 181.0±68.2 h, 111.0±63.1 h, 76.0±37.2 h, the mean drainage volume was 1 413.0±500.9 ml, 1 005.0±686.4 ml, 776.0±505.8 ml, and the mean hospital stay time following chest tube removal was 19.0±9.7 d, 14.0±8.0 d, 9.0±4.8 d in the group Ⅰ,Ⅱ and Ⅲ, respectively, had significantly difference among the three groups (P=0.000). The 13 patients required reintervention after chest tube removal due to pleural effusion accumulation and it had no differences among the three groups (P>0.05). Chest pain relieved essentially after chest tube removal in all patients.ConclusionA drainage volume of ≤300 ml/d as a threshold for chest tube removal after resection of lung or esophageal cancer can shorten postoperative hospital stay and accelerate early recovery of the patients.

关键词: 肺癌; 食管癌; 手术; 拔胸管时机

Key words: Lung cancer; esophageal cancer; resection; timing of chest tube removal

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