Division of Thoracic Surgery, Department of General Surgery, Atrium Medical Centre Parkstad, PO Box 4446, 6401 CX Heerlen, The Netherlands.
Eur J Cardiothorac Surg. 2011 Apr;39(4):575-8. doi: 10.1016/j.ejcts.2010.08.002. Epub 2010 Sep 15.
Chest tubes induce morbidity such as pain, decrease mobility, increase the risk of infection, and prolong the length of hospital stays. This study evaluates a chest-tube protocol containing a high-drainage threshold and a short time period of drainage.
A retrospective study was performed with data collected from all elective complete video-assisted thoracoscopic (c-VATS) (bi-)lobectomies between March 2006 and December 2009. All patients had one chest-tube, postoperatively. The chest tube was removed if there was no air leakage and there was a drainage volume of 400 ml (24 h)(-1) or less. We aimed to remove the chest tube on postoperative day 1.
This series consists of 110 lobectomies and six bilobectomies. The median duration of chest-tube placement was 1.0 day. In 58.8% of patients (confidence interval (CI) 95%: 49.5-68.0), the drain was removed within 24 h of operation and in 82.5% (CI 95%: 74.2-88.7) within 48 h. In six (6.2%) patients, subcutaneous emphysema developed while the drain was still in place, and was treated with removal of the drain. Persistent air leakage was seen in four (3.4%) patients. One (0.9%) persisting pneumothorax was diagnosed. A pneumothorax after removal of the drain was not diagnosed. No major complications developed in 98 patients (84.5%). The median day of discharge was postoperative day 4.
This study shows it is safe, after c-VATS (bi-)lobectomy, to remove the chest tube within 24 h in 58.8%, and within 48 h in 82.5% of patients. As was also shown in other studies, this leads to shorter length of hospital stays, lower costs, and most importantly, reduces patient morbidity without the added risk of complications.
胸腔引流管会引起疼痛、降低活动能力、增加感染风险并延长住院时间等并发症。本研究评估了一种胸腔引流管方案，该方案设定了较高的引流阈值，并将引流时间缩短。
对 2006 年 3 月至 2009 年 12 月间所有接受择期完全电视辅助胸腔镜（c-VATS）（双）肺叶切除术的患者进行回顾性研究。所有患者术后均留置一根胸腔引流管。当无空气漏出且引流量（24 小时）（-1）＜400ml 时，即可将引流管拔出。我们的目标是术后第 1 天将引流管拔出。
该系列包括 110 例肺叶切除术和 6 例双肺叶切除术。胸腔引流管放置的中位时间为 1.0 天。在 58.8%（置信区间（CI）95%：49.5-68.0）的患者中，引流管在术后 24 小时内拔出，82.5%（CI 95%：74.2-88.7）的患者在术后 48 小时内拔出。在 6 名（6.2%）患者中，当引流管仍在位时发生皮下气肿，通过拔出引流管进行治疗。4 名（3.4%）患者出现持续漏气。1 名（0.9%）患者持续气胸。未发现引流管拔出后气胸。98 名（84.5%）患者未出现重大并发症。中位出院时间为术后第 4 天。
c-VATS（双）肺叶切除术后，58.8%的患者可在 24 小时内、82.5%的患者可在 48 小时内安全地拔出胸腔引流管。与其他研究一样，这可导致住院时间更短、成本更低，最重要的是，降低患者发病率，而不会增加并发症风险。
