Guerrera Francesco, Filosso Pier Luigi, Pompili Cecilia, Olivetti Stefania, Roffinella Matteo, Imperatori Andrea, Brunelli Alessandro
Department of Surgical Science, University of Torino, Torino, Italy.
Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy.
J Vis Surg. 2018 Jan 29;4:26. doi: 10.21037/jovs.2018.01.07. eCollection 2018.
The presence of air leak following lung resection remains a frequent problem, which may prolong hospital stay and increase hospital costs. In the past, some studies documented the efficacy of soft and flexible chest tube in patients who underwent thoracic surgery. Nevertheless, safety in case of post-operative large air or liquid leak remains questionable. The objective of this study was to verify through a multicentre study the safety and the effectiveness of the coaxial chest tube in a consecutive series of selected patients who underwent anatomical pulmonary resection and with an active and large air leak.
Between October 2016 and September 2017, data from patients submitted to anatomical lung resection with curative intent and operated in two Department of Thoracic Surgery of two different were prospectively collected. The inclusion criteria consisted in the presence of an air leak greater than 50 mL/min measured with a digital drainage system during the 3 postoperative hours. A descriptive statistic was used to report the incidence of complications assumed to be associated with the use of the coaxial drain.
Forty-eight consecutive patients (27 males) submitted to lobectomy (37 patients: 77%) or anatomic segmentectomies (11 patients) were included in the analyses. Thirty-four operations (71%) were performed by video-assisted thoracic surgery (VATS). The median duration of chest tubes was 13 days [interquartile range (IQR), 4-19] and the median duration of air leak was 9 days (IQR, 2-17.5). No patient had undrained postoperative pleural effusion judged to require an additional chest tube placement. There were 12 (25%) cases of clinically or radiologically significant surgical emphysema; in none of these patients any additional procedure or re-operation was required, and they were treated conservatively by increasing the level of suction.
Our experience with this novel Coaxial Drain was satisfactory with no clinically relevant complication caused using this drain, no need to insert additional drain or replace the existing one with another drain a duration of air leak and chest tubes as well as the incidence of subcutaneous emphysema that was in line with what observed in the daily practice in similar highly selected patients with large air leak.
肺切除术后漏气仍是一个常见问题，这可能会延长住院时间并增加住院费用。过去，一些研究记录了柔软灵活的胸管在接受胸外科手术患者中的疗效。然而，术后大量漏气或液漏情况下的安全性仍存在疑问。本研究的目的是通过一项多中心研究，验证同轴胸管在一系列连续选择的、接受解剖性肺切除且存在活跃大量漏气的患者中的安全性和有效性。
在2016年10月至2017年9月期间，前瞻性收集了在两个不同胸外科接受根治性解剖性肺切除患者的数据。纳入标准为术后3小时内使用数字引流系统测得漏气量大于50 mL/分钟。采用描述性统计报告假定与使用同轴引流管相关的并发症发生率。
48例连续患者（27例男性）接受了肺叶切除术（37例患者：77%）或解剖性肺段切除术（11例患者）并纳入分析。34例手术（71%）通过电视辅助胸腔镜手术（VATS）进行。胸管留置的中位时间为13天[四分位间距（IQR），4 - 19]，漏气的中位时间为9天（IQR，2 - 17.5）。没有患者术后出现未引流的胸腔积液且被判定需要额外放置胸管。有12例（25%）临床或放射学上显著的手术性气肿病例；这些患者均无需任何额外操作或再次手术，通过增加吸引水平进行保守治疗。
我们使用这种新型同轴引流管的经验令人满意，使用该引流管未引起临床相关并发症，无需插入额外引流管或更换现有引流管，漏气和胸管留置时间以及皮下气肿发生率与日常实践中在类似选择的大量漏气患者中观察到的情况一致。
