Koç Togay, Routledge Tom, Chambers Anthony, Scarci Marco
Department of Thoracic Surgery, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK.
Interact Cardiovasc Thorac Surg. 2010 Jun;10(6):1022-5. doi: 10.1510/icvts.2010.232892. Epub 2010 Mar 22.
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed whether insertion of an intercostal chest drain prolongs the length of stay of patients undergoing lung biopsy. Altogether 210 papers were found using the reported search, of which 10 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that where an intraoperative check reveals no air leak, chest drain should be avoided if possible in order to discharge patients earlier. Where chest drain is used following video-assisted thoracoscopic surgery lung biopsy, early removal results in reduced pain and earlier discharge. Four studies advocate early chest tube removal, allowing discharge of 95% within 24 h in one study, reduced hospital stay from 3.9+/-2.1 days to 2+/-1 days (P=0.001) in another, and a median stay of 1.2 days (range 0-7 days) in a third. Removal of chest drain within 1 h of the operation was possible in 92% of patients (one study), significantly reducing pain (P=0.03, P=0.005; two studies) and postoperative complications (P=0.01; one study) compared with conventional treatment. Five studies in which patients were managed without chest drain following intraoperative air leak checks, reduced hospital stay vs. conventional management (two studies; 2 vs. 3, P<0.001, 1 vs. 3, P<0.01) but results in no difference in complication rates (three studies: pneumothoraces requiring chest drain; 2 vs. 2, P=non-significant; 0 vs. 0; 0 vs. 0) or pain score (two studies; 0.77 vs. 0.76, P=0.894; 5 vs. 5, P=0.81).
根据结构化方案撰写了一篇胸外科最佳证据主题。该问题探讨了肋间胸腔引流管的插入是否会延长接受肺活检患者的住院时间。通过报告的检索共找到210篇论文，其中10篇代表回答该临床问题的最佳证据。这些论文的作者、期刊、出版日期和国家、研究的患者组、研究类型、相关结局和结果均列于表格中。我们得出结论，若术中检查未发现漏气，应尽可能避免放置胸腔引流管，以便患者更早出院。在电视辅助胸腔镜手术肺活检后使用胸腔引流管的情况下，早期拔除可减轻疼痛并使患者更早出院。四项研究主张早期拔除胸管，一项研究显示95%的患者在24小时内可出院，另一项研究将住院时间从3.9±2.1天缩短至2±1天（P=0.001），第三项研究的中位住院时间为1.2天（范围0-7天）。92%的患者（一项研究）在手术1小时内即可拔除胸管，与传统治疗相比，疼痛显著减轻（P=0.03，P=0.005；两项研究）且术后并发症减少（P=0.01；一项研究）。五项研究中，患者在术中漏气检查后未放置胸管进行管理，与传统管理相比住院时间缩短（两项研究；2天对3天，P<0.001，1天对3天，P<0.01），但并发症发生率无差异（三项研究：需要放置胸管的气胸；2例对2例，P=无显著性差异；0例对0例；0例对0例）或疼痛评分无差异（两项研究；0.77对0.76，P=0.894；5分对5分，P=0.81）。
