Kim Samuel S, Khalpey Zain, Daugherty Sherry L, Torabi Mohammad, Little Alex G
Division of Cardiothoracic Surgery, University of Arizona, Tucson, Arizona.
Division of Cardiothoracic Surgery, University of Arizona, Tucson, Arizona.
Ann Thorac Surg. 2016 Mar;101(3):1082-8. doi: 10.1016/j.athoracsur.2015.09.079. Epub 2015 Dec 8.
This study determined patterns of chest tube (CT) selection and management after open lobectomy and minimally invasive lobectomy by thoracic surgeons.
Surveys were sent electronically to 5,175 thoracic surgeons, and 475 were completed. Responses, blinded so individuals could not be identified, were analyzed and compared according to surgeon characteristics (academic/private practice, years in practice, lobectomy volume, and geographic region). All indicated differences were statistically significant (p < 0.05 by χ(2) tests).
CT selection: Most surgeons prefer rigid tubes, and the size most commonly used was 28F. Most place 2 CTs after open lobectomy and 1 CT after minimally invasive lobectomy. Academic surgeons are more likely than private surgeons to use 1 tube after open lobectomy, but both prefer 1 tube after minimally invasive lobectomy. Younger surgeons and high-volume surgeons are more likely to use 1 CT than senior surgeons and low-volume surgeons after both open lobectomy and minimally invasive lobectomy. CT management: Academic and younger surgeons remove the CT sooner after open lobectomy. Younger and high-volume surgeons remove the CT with greater drainage amounts. All groups remove CTs sooner after minimally invasive lobectomy than after open lobectomy. Approximately half of surgeons get a daily chest roentgenogram. Younger and low-volume surgeons are most likely to discharge patients with Heimlich valves, although overall use was in less than 5% (49 of 475) of respondents. Most surgeons believe clinical experience rather than training or the literature determined their CT strategy.
This survey determined the difference in CT management among various groups of surgeons. Clinical experience was the most important factor in determining their CT strategy.
本研究确定了胸外科医生在开放性肺叶切除术和微创肺叶切除术后胸管（CT）的选择和管理模式。
通过电子方式向5175名胸外科医生发送调查问卷，共完成475份回复。对回复进行分析并根据外科医生的特征（学术/私人执业、执业年限、肺叶切除量和地理区域）进行比较，所有显示的差异均具有统计学意义（χ²检验，p<0.05）。
CT选择：大多数外科医生更喜欢使用硬质胸管，最常用的尺寸是28F。大多数医生在开放性肺叶切除术后放置2根胸管，在微创肺叶切除术后放置1根胸管。学术外科医生在开放性肺叶切除术后比私人外科医生更倾向于使用1根胸管，但在微创肺叶切除术后两者都更喜欢使用1根胸管。在开放性肺叶切除术和微创肺叶切除术后，年轻外科医生和高手术量外科医生比资深外科医生和低手术量外科医生更倾向于使用1根胸管。CT管理：学术外科医生和年轻外科医生在开放性肺叶切除术后更早拔除胸管。年轻和高手术量外科医生在胸管引流量更大时拔除胸管。所有组在微创肺叶切除术后比在开放性肺叶切除术后更早拔除胸管。大约一半的外科医生每天进行胸部X线检查。年轻和低手术量外科医生最有可能让患者带着海姆利克阀出院，尽管总体使用率不到5%（475名受访者中的49名）。大多数外科医生认为临床经验而非培训或文献决定了他们的胸管策略。
本次调查确定了不同组外科医生在胸管管理方面的差异。临床经验是决定他们胸管策略的最重要因素。
