Deng Bo, Qian Kai, Zhou Jing-Hai, Tan Qun-You, Wang Ru-Wen
Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042, People's Republic of China.
World J Surg. 2017 Aug;41(8):2039-2045. doi: 10.1007/s00268-017-3975-x.
The aim of this meta-analysis and systematic review of published evidence was to optimize chest tube management for fast-track rehabilitation of lung cancer patients after video-assisted thoracic surgery (VATS).
The PubMed, Web of Science, and EMBASE databases were searched to identify all studies that addressed the issue of chest tube management after VATS for lung cancer. Finally, 35 articles were included for analysis, i.e., 29 randomized controlled trials and 6 clinical trials.
After synthesis of the published evidence, the following protocol for chest tube drainage was formulated: (1) after VATS lung wedge resection, chest tube drainage can be omitted in selected cases; (2) normally, one 28Fr chest tube (or 19Fr Blake drain) is placed; (3) the use of a digital monitoring system is recommended; (4) in case of increasing pneumothorax or severe air leakage supported by digital recording system, the tube should be placed with active suction; and (5) the chest tube can be removed within 48 h postoperatively when air leakage is resolved and fluid drainage is <400 mL/day.
Further multicenter studies are warranted based on the variations of body sizes among different ethnicities.
本荟萃分析及已发表证据的系统评价旨在优化电视辅助胸腔镜手术（VATS）后肺癌患者快速康复的胸管管理。
检索PubMed、科学网和EMBASE数据库，以识别所有涉及VATS后肺癌胸管管理问题的研究。最终，纳入35篇文章进行分析，即29项随机对照试验和6项临床试验。
综合已发表的证据后，制定了以下胸管引流方案：（1）VATS肺楔形切除术后，部分病例可省略胸管引流；（2）通常放置一根28Fr胸管（或19Fr Blake引流管）；（3）建议使用数字监测系统；（4）若气胸增加或有数字记录系统支持的严重漏气，应主动吸引放置胸管；（5）术后48小时内，若漏气消失且引流量<400mL/天，可拔除胸管。
鉴于不同种族间体型差异，有必要开展进一步的多中心研究。
