Department of Surgery and Clinical Science, Division of Chest Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan.
Eur J Cardiothorac Surg. 2013 Aug;44(2):225-9; discussion 229. doi: 10.1093/ejcts/ezs679. Epub 2013 Jan 12.
Absorbable mesh and fibrin glue applied to prevent alveolar air leakage contribute to reducing the length of chest tube drainage, length of hospitalization and the rate of pulmonary complications. This study investigated the feasibility of omitting chest tube drainage in selected patients undergoing thoracoscopic major lung resection.
Intraoperative air leakages were sealed with fibrin glue and absorbable mesh in patients undergoing thoracoscopic major lung resection. The chest tube was removed just after tracheal extubation if no air leakages were detected in a suction-induced air leakage test, which is an original technique to confirm pneumostasis. Patients with bleeding tendency or extensive thoracic adhesions were excluded.
Chest tube drainage was omitted in 29 (58%) of 50 eligible patients and was used in 21 (42%) on the basis of suction-induced air leakage test results. Male gender and compromised pulmonary function were significantly associated with the failure to omit chest tube drainage (both, P < 0.05). Regardless of omitting the chest tube drainage, there were no adverse events during hospitalization, such as subcutaneous emphysema, pneumothorax, pleural effusion or haemothorax, requiring subsequent drainage. Furthermore, there was no prolonged air leakage in any patients: The mean length of chest tube drainage was only 0.9 days. Omitting the chest tube drainage was associated with reduced pain on the day of the operation (P = 0.046).
The refined strategy for pneumostasis allowed the omission of chest tube drainage in the majority of patients undergoing thoracoscopic major lung resection without increasing the risk of adverse events, which may contribute to a fast-track surgery.
应用可吸收网片和纤维蛋白胶预防肺泡漏气有助于减少胸腔引流管的引流时间、住院时间和肺部并发症的发生率。本研究探讨了在接受胸腔镜肺叶切除术的患者中选择性地避免胸腔引流的可行性。
在接受胸腔镜肺叶切除术的患者中，用纤维蛋白胶和可吸收网片密封术中的空气漏口。如果在吸引诱导的空气漏口测试中没有发现空气漏口，即在一个原创的确认肺稳定的技术下，在气管拔管后立即移除胸腔引流管。有出血倾向或广泛胸粘连的患者被排除在外。
50 名符合条件的患者中有 29 名（58%）成功避免了胸腔引流管，根据吸引诱导的空气漏口测试结果，21 名（42%）患者需要使用。男性性别和受损的肺功能与未能避免胸腔引流管密切相关（均 P<0.05）。无论是否避免使用胸腔引流管，住院期间均未发生任何不良事件，如皮下气肿、气胸、胸腔积液或血胸，需要随后引流。此外，没有患者出现长时间的空气漏口：胸腔引流管的平均引流时间仅为 0.9 天。避免使用胸腔引流管与手术当天的疼痛减轻相关（P=0.046）。
精细的稳定策略使大多数接受胸腔镜肺叶切除术的患者无需增加不良事件的风险即可避免胸腔引流管的使用，这可能有助于快速康复。
