Pawlak Krystian, Gąsiorowski Łukasz, Gabryel Piotr, Smoliński Szymon, Dyszkiewicz Wojciech
Department of Thoracic Surgery, Karol Marcinkowski University of Medical Sciences, Poznań, Poland.
Department of Intensive Care and Pain Management, Faculty of Health Sciences, Karol Marcinkowski University of Medical Sciences, Poznań, Poland.
Ann Thorac Surg. 2017 Dec;104(6):1852-1857. doi: 10.1016/j.athoracsur.2017.06.052. Epub 2017 Oct 14.
The routine use of postoperative pleural cavity drainage after the Nuss procedure is not widely accepted, and its limited use depends on experience. This study analyzed the influence of pleural drainage in the surgical treatment of patients with pectus excavatum on the prevention of pneumothorax and the efficacy of using drainage after a corrective operation.
From November 2013 to May 2015, 103 consecutive patients with pectus excavatum, aged 11 to 39 years, underwent surgical treatment by the Nuss procedure. Patients were prospectively randomized into two groups. In 58 patients, a 28F chest tube was routinely introduced into the right pleural cavity during procedure for 2 consecutive days (group I). In the remaining 45 patients, the drain was not inserted (group II).
No statistically significant differences were found between the study groups, including sex, age, body mass index, or clinical subjective and objective factors in the preoperative evaluation. Group II manifested more complications in the early postoperative period; however, this was not statistically significant (group I vs group II; p = 0.0725). Pneumothorax requiring additional chest tube placement was statistically significant (group I vs group II; p = 0.0230). Other complications were also more frequent among patients from group II, although this did not reach statistical significance. Follow up was 22.9 ± 6.4 months.
Routine drainage of the pleural cavity during the Nuss procedure significantly reduces the incidence of postoperative pneumothorax and should be considered as a routine procedure.
努氏手术（Nuss手术）术后常规进行胸腔引流未被广泛接受，其使用受限取决于经验。本研究分析了胸腔引流在漏斗胸患者手术治疗中对预防气胸的影响以及矫正手术后使用引流的效果。
2013年11月至2015年5月，103例年龄在11至39岁的连续性漏斗胸患者接受了努氏手术治疗。患者被前瞻性随机分为两组。58例患者在手术过程中常规将一根28F胸管置入右侧胸腔，持续2天（I组）。其余45例患者未置入引流管（II组）。
研究组之间在性别、年龄、体重指数或术前评估的临床主观和客观因素方面未发现统计学上的显著差异。II组在术后早期出现更多并发症；然而，这在统计学上无显著意义（I组与II组比较；p = 0.0725）。需要额外放置胸管的气胸情况在统计学上有显著差异（I组与II组比较；p = 0.0230）。II组患者中其他并发症也更常见，尽管未达到统计学意义。随访时间为22.9±6.4个月。
努氏手术期间常规进行胸腔引流可显著降低术后气胸的发生率，应被视为常规操作。
