Asti Emanuele, Sironi Andrea, Bonitta Gianluca, Bernardi Daniele, Bonavina Luigi
Division of General Surgery, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan Medical School , Milano, Italy .
J Laparoendosc Adv Surg Tech A. 2018 Apr;28(4):429-433. doi: 10.1089/lap.2017.0580. Epub 2017 Dec 13.
Intercostal pleural drainage is standard practice after transthoracic esophagectomy but has some drawbacks. We hypothesized that a transhiatal pleural drain introduced through the subxyphoid port site incision at laparoscopy can be as effective as the intercostal drainage and may enhance patient recovery.
A proof of concept study was designed to assess a new method of pleural drainage in patients undergoing hybrid Ivor Lewis esophagectomy (laparoscopy and right thoracotomy). The main study aims were safety and efficacy of transhiatal pleural drainage with a 15 Fr Blake tube connected to a portable vacuum system. Pre- and postoperative data, mean duration, and total and daily output of drainage were recorded in an electronic database. Postoperative complications were scored according to the Dindo-Clavien classification.
Between June 2015 and December 2016, 50 of 63 consecutive patients met the criteria for inclusion in the study. No conversions from the portable vacuum system to underwater seal and suction occurred. There was no mortality. The overall morbidity rate was 40%. Two patients (4%) required reoperation for hemothorax and chylothorax, respectively. Percutaneous catheter drainage for residual pneumothorax was necessary in 2 patients (4%) on postoperative day 2. The mean duration of drainage was 7 days (interquartile range [IQR] = 2), and the total volume of drain output was 1580 mL (IQR = 880). No pleural effusion on chest X-ray was detected at the 3-month follow-up visit.
Transhiatal pleural drainage is safe and effective after hybrid Ivor Lewis esophagectomy and could replace the intercostal drain in selected patients.
经胸段食管癌切除术后，肋间胸膜引流是标准操作，但存在一些缺点。我们推测，在腹腔镜手术时经剑突下切口置入的经裂孔胸膜引流管与肋间引流同样有效，且可能促进患者康复。
本概念验证性研究旨在评估在接受Ivor Lewis食管切除术（腹腔镜手术联合右开胸手术）的患者中采用一种新的胸膜引流方法的效果。主要研究目的是使用连接便携式负压系统的15F Blake引流管进行经裂孔胸膜引流的安全性和有效性。术前和术后数据、平均引流持续时间以及引流总量和每日引流量均记录于电子数据库中。术后并发症按照Dindo-Clavien分类法进行评分。
2015年6月至2016年12月期间，63例连续患者中有50例符合纳入本研究的标准。未出现从便携式负压系统转换为水封瓶加吸引装置的情况。无死亡病例。总体发病率为40%。两名患者（4%）分别因血胸和气胸需要再次手术。术后第2天，2例患者（4%）因残留气胸需要进行经皮导管引流。平均引流持续时间为7天（四分位间距[IQR]=2），引流总量为1580mL（IQR=880）。在3个月的随访中，胸部X线检查未发现胸腔积液。
Ivor Lewis食管切除术后，经裂孔胸膜引流安全有效，在部分患者中可替代肋间引流。
