Vyas Soumil, Mitchell Ian, Smart Jamie, Stoker David, Woolf Adam K
Division of Oesophago Gastric Surgery, Regional Oesophago Gastric Cancer Unit, University College Hospital, 235 Euston Road, London, NW1 2BU, UK.
Eur J Cardiothorac Surg. 2009 Apr;35(4):694-8. doi: 10.1016/j.ejcts.2008.11.018. Epub 2009 Jan 23.
Underwater seal drainage of the pleural cavity has been standard practice after transthoracic oesophagectomy. However these chest tubes cause pain and hamper mobility, thereby causing significant morbidity and delaying recovery. We postulated that if complete lung expansion and optimum pulmonary function could be achieved and maintained following a transthoracic oesophagectomy using simple gravity aided transabdominal tube drainage of the pleural cavity, then these may be a simpler alternative to the conventional underwater seal chest drains.
A total of 50 patients had transthoracic oesophagectomy for oesophageal cancer. Of the cohort, 44 patients were fitted with the transabdominal drain described and hence had 'modified pleural drainage' following the oesophagectomy. All patients had a posterior mediastinal drain placed in either the right or the left pleural cavity during the oesophagectomy. The tube drain was inserted into the pleural cavity from the abdomen and placed into the desired position across the diaphragmatic hiatus. The drain was managed in the conventional manner and patients were monitored postoperatively for any developing pleural collections through serial chest X-rays. Respiratory function was closely monitored.
The drains were removed without any significant respiratory complications by the 8th postoperative day in 86% of the patients. Only three patients (7%) developed clinically significant recurrent pleural effusions, causing respiratory compromise meriting further drainage. This was easily and safely managed using fine bore pigtail drains inserted under ultrasound guidance.
Transabdominal gravity aided tube drainage of the mediastinum and the pleural cavity is an effective and safe means of draining the chest, following uncomplicated transthoracic oesophagectomy.
经胸段食管癌切除术后，胸腔闭式引流一直是标准操作。然而，这些胸管会引起疼痛并妨碍活动，从而导致显著的发病率并延迟恢复。我们推测，如果在经胸段食管癌切除术后，通过简单的重力辅助经腹胸腔置管引流能够实现并维持肺的完全扩张和最佳肺功能，那么这可能是传统胸腔闭式引流管的一种更简单的替代方法。
共有50例患者接受了经胸段食管癌切除术。在该队列中，44例患者安装了所述的经腹引流管，因此在食管癌切除术后进行了“改良胸腔引流”。所有患者在食管癌切除术中均在右侧或左侧胸腔放置了后纵隔引流管。引流管从腹部插入胸腔，并通过膈肌裂孔放置到所需位置。引流管采用常规方式管理，术后通过系列胸部X线检查监测患者是否出现胸腔积液。密切监测呼吸功能。
86%的患者在术后第8天拔除引流管，未出现任何严重的呼吸并发症。只有3例患者（7%）出现了具有临床意义的复发性胸腔积液，导致呼吸功能不全，需要进一步引流。这通过在超声引导下插入细孔猪尾引流管得以轻松、安全地处理。
对于无并发症的经胸段食管癌切除术，经腹重力辅助纵隔和胸腔置管引流是一种有效且安全的胸腔引流方法。
