Miller Daniel L, Helms Gerald A, Mayfield William R
WellStar Thoracic Surgery, WellStar Health System/Mayo Clinic Care Network Marietta, Georgia.
WellStar Thoracic Surgery, WellStar Health System/Mayo Clinic Care Network Marietta, Georgia.
Ann Thorac Surg. 2016 Sep;102(3):955-961. doi: 10.1016/j.athoracsur.2016.03.089. Epub 2016 May 25.
The purpose of this study was to assess the efficacy of a digital versus traditional drainage system on hospitalization for patients undergoing video-assisted thoracoscopic surgery (VATS) anatomic lung resection.
Consecutive patients who underwent VATS anatomic lung resection (July 2014 through January 2015) for lung cancer were analyzed. Patients were managed with overnight suction (-20 cm H2O) followed by gravity drainage (water seal or -8 cm H2O) in both the traditional and digital drainage systems, respectively; the digital system also allowed for continuous monitoring of air leaks. Chest tubes were removed when the air leak was absent for 12 hours and pleural drainage was less than 300 mL/24 h; patient outcomes selected by propensity matching were compared.
The VATS lung resections (lobectomy or segmentectomy) were performed in 108 patients during the 7-month study period. The pleural cavity was drained with the traditional system in 75 patients and with the digital system in 33 patients. By propensity score matching at a 2:1 ratio, 40 patients were placed in the traditional group and 20 patients, in the digital group for analysis. Demographics, percent predicted forced expiratory volume in 1 second, tumor size, stage, and type of resection were similar between the groups. The majority of patients (85%) underwent a lobectomy. There were no operative deaths. Overall complications were fewer in the digital system group (22%) compared with the traditional system group (35%; p = 0.01). Median air leak days (-1.1), chest tube days (-1.6), and total hospital stay (-1.5) were significantly reduced in the digital drainage system group.
Patients undergoing VATS lung resections who were managed postoperatively with a digital drainage system experienced less morbidity and decreased hospitalization. A digital drainage system appears to be a safe alternative for management of the pleural cavity after VATS anatomic lung resection.
本研究旨在评估数字引流系统与传统引流系统对接受电视辅助胸腔镜手术（VATS）解剖性肺切除患者住院治疗的效果。
分析2014年7月至2015年1月期间连续接受VATS解剖性肺切除治疗肺癌的患者。在传统引流系统和数字引流系统中，患者分别先进行夜间负压吸引（-20 cm H₂O），然后进行重力引流（水封或-8 cm H₂O）；数字系统还可连续监测漏气情况。当漏气消失12小时且胸腔引流量小于300 mL/24小时时拔除胸管；通过倾向匹配选择患者结局进行比较。
在7个月的研究期间，108例患者接受了VATS肺切除（肺叶切除术或肺段切除术）。75例患者采用传统系统进行胸腔引流，33例患者采用数字系统进行胸腔引流。通过倾向评分以2:1的比例进行匹配，将40例患者纳入传统组，20例患者纳入数字组进行分析。两组患者的人口统计学特征、预测的1秒用力呼气量百分比、肿瘤大小、分期和切除类型相似。大多数患者（85%）接受了肺叶切除术。无手术死亡病例。与传统系统组（35%）相比，数字系统组的总体并发症较少（22%；p = 0.01）。数字引流系统组的中位漏气天数（-1.1）、胸管留置天数（-1.6）和总住院天数（-1.5）均显著减少。
接受VATS肺切除术后采用数字引流系统管理的患者发病率较低，住院时间缩短。数字引流系统似乎是VATS解剖性肺切除术后胸腔管理的一种安全替代方法。
