Zhang Ye, Li Hui, Hu Bin, Hou Sheng-Cai, Li Tong, Miao Jin-Bai, Wang Yang, You Bin, Fu Yi-Li, Chen Qi-Rui, Zhang Wen-Qian, Chen Shuo, Hu Xiao-Xing
Department of Thoracic Surgery, Beijing Chao-yang Hospital, Capital Medical University, Beijing 100020, China.
Zhonghua Wai Ke Za Zhi. 2013 Jun 1;51(6):533-7.
To evaluate the feasibility and safety of early chest tube removal after lobectomies for lung diseases.
A prospective randomized control study was performed with data collected from lobectomies between March 2012 and September 2012. Eligible patients (n = 70) were randomized into two groups; early removal group (removal of chest tube when drainage less than 300 ml/24 h, n = 41) and traditional management group (removal of chest tube when drainage less than 100 ml/24 h, n = 29). Criteria for early removal were established and met before chest tube removal. The volume and character of drainage, time of extracting drainage tube and postoperative hospital stay were measured. All patients received standard care during hospital admission and a follow-up visit was performed after 7 days of discharge from hospital.
There were no differences between two groups with respect to age, sex, comorbidities, or pathologic evaluation of resection specimens. The median volume of drainage within 24 h after surgery was 300 ml and within 48 h was 250 ml, there was significantly different between two groups (Z = -2.059, P = 0.039). Patients undergoing early removal management had a shorter Chest tube duration (44 hours vs. 67 hours, Z = -2.914, P = 0.004) and a shorter postoperative hospital stay (5.0 days vs. 6.0 days, Z = -3.882, P = 0.000). Analysis of data showed no statistically significant differences between the rate of pleural effusions developed, thoracentesis and complications, one week after discharge from hospital.
Compared to the traditional management group (drainage ≤ 100 ml/24 h), early removal of chest tube after lobectomy (drainage ≤ 300 ml/24 h) is feasible and safe. It could result in a shorter hospital stay, and most importantly, reduces morbidity without the added risk of complications.
评估肺部疾病肺叶切除术后早期拔除胸管的可行性和安全性。
进行一项前瞻性随机对照研究，收集2012年3月至2012年9月期间肺叶切除术的数据。符合条件的患者（n = 70）被随机分为两组；早期拔除组（当引流量小于300 ml/24 h时拔除胸管，n = 41）和传统管理组（当引流量小于100 ml/24 h时拔除胸管，n = 29）。在拔除胸管前制定并满足早期拔除的标准。测量引流量和性质、拔除引流管的时间以及术后住院时间。所有患者在住院期间接受标准护理，并在出院7天后进行随访。
两组在年龄、性别、合并症或切除标本的病理评估方面无差异。术后24小时内引流的中位数为300 ml，48小时内为250 ml，两组之间有显著差异（Z = -2.059，P = 0.039）。接受早期拔除管理的患者胸管留置时间较短（44小时对67小时，Z = -2.914，P = 0.004），术后住院时间较短（5.0天对6.0天，Z = -3.882，P = 0.000）。数据分析显示，出院一周后发生胸腔积液的发生率、胸腔穿刺术和并发症方面无统计学显著差异。
与传统管理组（引流量≤100 ml/24 h）相比，肺叶切除术后早期拔除胸管（引流量≤300 ml/24 h）是可行且安全的。它可以缩短住院时间，最重要的是，降低发病率且无额外的并发症风险。
