影响经胸食管切除术后胸腔引流液量的危险因素。

Risk factors influencing the pleural drainage volume after transthoracic oesophagectomy.

机构信息

Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.

出版信息

Eur J Cardiothorac Surg. 2013 Jun;43(6):1116-20. doi: 10.1093/ejcts/ezs556. Epub 2012 Oct 25.

DOI:10.1093/ejcts/ezs556

PMID:23100290

Abstract

OBJECTIVES

The objective of this study was to clarify the factors influencing pleural drainage volume after transthoracic oesophagectomy and to determine criteria for the selection of patients who would benefit from the early removal of chest drains.

METHODS

Clinicopathological characteristics of 155 patients who underwent transthoracic oesophagectomy were prospectively collected, and the daily drainage volume of each patient was retrospectively reviewed. Potential risk factors were compared between the high-output group (n = 39) and low-output group (n = 116), which were dichotomized using the 75th percentile of total pleural drainage volume of the total study population. Multivariate logistic regression analyses were used to identify independent risk factors.

RESULTS

The median duration of drainage was 10 days, with a median total drainage volume of 2258 ml. Of 27 potential risk factors influencing the drainage volume, creatinine clearance (P = 0.04), operative approach (P = 0.03) and thoracic duct removal (P = 0.01) were significantly associated with the total pleural drainage volume. The removal of the thoracic duct (P = 0.02; odds ratio, 4.02; 95% confidence interval 1.20-13.41) and lower creatinine clearance (P = 0.04; odds ratio, 1.02; 95% confidence interval 1.00-1.04) was independent risk factors for increased pleural drainage volume after transthoracic oesophagectomy.

CONCLUSIONS

The early removal of chest drains may be possible in patients without these risk factors.

摘要

目的

本研究旨在阐明经胸食管切除术（transthoracic oesophagectomy）后胸腔引流体积的影响因素，并确定选择哪些患者可从早期拔除胸腔引流管中获益的标准。

方法

前瞻性收集了 155 例接受经胸食管切除术的患者的临床病理特征，并回顾性分析了每位患者的每日引流体积。将高输出组（n=39）和低输出组（n=116）的潜在风险因素与总研究人群胸腔引流总量的第 75 百分位进行二分类比较。采用多变量逻辑回归分析确定独立的危险因素。

结果

引流时间中位数为 10 天，总引流量中位数为 2258ml。在 27 个可能影响引流体积的潜在危险因素中，肌酐清除率（P=0.04）、手术入路（P=0.03）和胸导管切除（P=0.01）与胸腔总引流量显著相关。切除胸导管（P=0.02；比值比，4.02；95%置信区间，1.20-13.41）和较低的肌酐清除率（P=0.04；比值比，1.02；95%置信区间，1.00-1.04）是经胸食管切除术后胸腔引流体积增加的独立危险因素。