Shackcloth Michael J, Poullis Michael, Jackson Mark, Soorae Ajaib, Page Richard D
Department of Thoracic Surgery, The Cardiothoracic Centre, Liverpool, United Kingdom.
Ann Thorac Surg. 2006 Sep;82(3):1052-6. doi: 10.1016/j.athoracsur.2006.04.015.
The aim of this study was to assess the value of instilling autologous blood into the pleural cavity to seal prolonged air leaks after lobectomy.
Of 319 lobectomies performed over an 18-month period, 22 patients (6.9%) experienced prolonged air leak (more than 5 days after surgery). Twenty patients consented to be randomly assigned to one of two treatment pathways. The study group received instillation of 120 mL autologous blood into their apical chest drain on the fifth postoperative day, and again if the air leak persisted on days 7 and 9 respectively. No anticoagulation was used for this blood. The control group continued to be treated by tube thoracostomy alone, but if the air leak was still present on the 10th postoperative day they "crossed over" and underwent intrapleural installation of blood as in the study group.
After instillation of blood, the air leak was sealed by the next day in 58.6% of treatments. The median length of air leak was 5 days in the study group and 11 days in the control group (p < 0.001). Time to chest drain removal (median 6.5 days versus 12 days) and hospital discharge (median 8 days versus 13.5 days) were both significantly (p < 0.001) shorter in the study group.
This technique is effective in sealing air leaks after lobectomy. It allows earlier chest drain removal and shortens hospital stay.
本研究旨在评估向胸腔内注入自体血以封闭肺叶切除术后持续漏气的价值。
在18个月期间进行的319例肺叶切除术中，22例患者（6.9%）出现持续漏气（术后超过5天）。20例患者同意被随机分配至两种治疗途径之一。研究组在术后第5天经胸腔顶端引流管注入120 mL自体血，若漏气在第7天和第9天仍持续，则再次注入。该血液未使用抗凝剂。对照组继续仅通过胸腔闭式引流进行治疗，但如果术后第10天仍有漏气，则“交叉”接受与研究组相同的胸腔内血液注入。
注入血液后，58.6%的治疗在次日漏气即被封闭。研究组漏气的中位时长为5天，对照组为11天（p<0.001）。研究组胸腔引流管拔除时间（中位6.5天对12天）和出院时间（中位8天对13.5天）均显著缩短（p<0.001）。
该技术在封闭肺叶切除术后漏气方面有效。它能使胸腔引流管更早拔除并缩短住院时间。
