Xie Hong-Ya, Xu Kai, Tang Jin-Xing, Bian Wen, Ma Hai-Tao, Zhao Jun, Ni Bin
Department of Thoracic Surgery, First Affiliated Hospital, Suzhou City, Jiangsu Province, China.
Department of Thoracic Surgery, First Affiliated Hospital, Suzhou City, Jiangsu Province, China
Interact Cardiovasc Thorac Surg. 2015 Aug;21(2):200-5. doi: 10.1093/icvts/ivv115. Epub 2015 May 15.
To study the feasible and safe volume threshold for chest tube removal following video-assisted thoracoscopic surgical lobectomy.
One hundred and sixty-eight consecutive patients (18 were excluded) who underwent video-assisted thoracoscopic surgery lobectomy or bilobectomy with two incisions between August 2012 and February 2014 were included. Eligible patients were randomized into three groups: Group A (chest tube was removed at a drainage volume of 150 ml/day or less. n = 49); Group B (chest tube was removed when the drainage volume was less than 300 ml/day. n = 50); Group C (chest tube was removed when the drainage volume was less than 450 ml/day. n = 51). The postoperative care of all patients was consistent. The time of extracting the drainage tube, postoperative hospital stay, postoperative visual analogue scale grades, dosage of analgesic, and the incidence of complications and thoracocentesis were measured.
Group B and C had a much shorter drainage time and postoperative hospital stay than Group A (P < 0.05). Compared with Group B, Group C had a notably shorter drainage time (P = 0.036). The postoperative hospital stay was not statistically different between Group B and Group C (P > 0.05). The mean dosage of pethidine hydrochloride was 248.9 ± 33.3 mg in Group B and 226.1 ± 32.7 mg in Group C (P > 0.05). The dosage of pethidine hydrochloride of Group A was significantly higher than that of Group B and C (P < 0.05). The total visual analogue scale (VAS) score during the five days showed no statistical differences compared with Group B and Group C (P > 0.05), Group A had a significantly higher total VAS score than Group B and C (P < 0.05). The number of patients who needed thoracentesis in Group C was more than those in Group B and A (P < 0.05). There were no statistically significant differences in the number of patients who needed reinsertion of chest drains among the three groups (P > 0.05).
A 300-ml/day volume threshold for chest tube removal after video-assisted thoracoscopic surgery lobectomy is feasible and safe, demonstating more advantages than the 150-ml/day volume threshold. However, a 450-ml/day volume threshold for chest tube removal may increase the risk of thoracentesis compared with the 300- and the 150-ml/day volume threshold.
研究电视辅助胸腔镜手术肺叶切除术后拔除胸管的可行且安全的引流量阈值。
纳入2012年8月至2014年2月期间连续接受电视辅助胸腔镜手术肺叶切除术或双叶切除术且有两个切口的168例患者（排除18例）。符合条件的患者被随机分为三组：A组（引流量每天150ml及以下时拔除胸管，n = 49）；B组（引流量小于300ml/天时拔除胸管，n = 50）；C组（引流量小于450ml/天时拔除胸管，n = 51）。所有患者的术后护理一致。测量拔除引流管的时间、术后住院时间、术后视觉模拟评分等级、镇痛药用量以及并发症和胸腔穿刺的发生率。
B组和C组的引流时间和术后住院时间比A组短得多（P < 0.05）。与B组相比，C组的引流时间明显更短（P = 0.036）。B组和C组的术后住院时间无统计学差异（P > 0.05）。B组盐酸哌替啶的平均用量为248.9±33.3mg，C组为226.1±32.7mg（P > 0.05）。A组盐酸哌替啶的用量明显高于B组和C组（P < 0.05）。五天内的视觉模拟量表（VAS）总分与B组和C组相比无统计学差异（P > 0.05），A组的VAS总分明显高于B组和C组（P < 0.05）。C组需要胸腔穿刺的患者数量多于B组和A组（P < 0.05）。三组中需要重新插入胸管的患者数量无统计学差异（P > 0.05）。
电视辅助胸腔镜手术肺叶切除术后胸管拔除的引流量阈值为300ml/天是可行且安全的，比150ml/天的引流量阈值更具优势。然而，与300ml/天和150ml/天的引流量阈值相比，450ml/天的胸管拔除引流量阈值可能会增加胸腔穿刺的风险。
