Asti Emanuele, Bernardi Daniele, Bonitta Gianluca, Bonavina Luigi
Division of General Surgery, Department of Biomedical Sciences for Health, University of Milan Medical School , IRCCS Policlinico San Donato, Milano, Italy .
J Laparoendosc Adv Surg Tech A. 2018 May;28(5):574-578. doi: 10.1089/lap.2018.0031. Epub 2018 Apr 5.
In a previous proof of concept study, transhiatal pleural drain has been shown to be safe and effective after hybrid Ivor Lewis esophagectomy. Aim of this study was to compare the short-term outcomes of transhiatal and intercostal pleural drainage.
This is an observational retrospective cohort study. Two methods of pleural drainage were compared in patients undergoing hybrid Ivor Lewis esophagectomy. Patients treated with a transhiatal drain connected to a vacuum bag were compared to a historical cohort of patients treated with the conventional intercostal drain connected to underwater seal and suction. Postoperative morbidity, total and daily drainage output, serum albumin levels, and total dose of paracetamol and ketorolac administered on demand were recorded.
Between January 2014 and December 2016, 50 patients with transhiatal drain and 50 with intercostal drains met the criteria for inclusion in the study. Demographic and clinicopathological variables were similar in the two groups. There was no statistically significant difference in the rate of postoperative complications. The total volume of drain output and the serum albumin levels were similar in the two groups. The total dose of ketorolac was significantly reduced in patients with transhiatal drain (P < .001).
Transhiatal pleural drainage connected to a portable vacuum system could safely replace the intercostal drain after hybrid Ivor Lewis esophagectomy. It has the potential to reduce postoperative pain and use of nonsteroidal anti-inflammatory drugs, and to enhance recovery from surgery.
在先前的一项概念验证研究中，经裂孔胸腔引流已被证明在杂交Ivor Lewis食管切除术后是安全有效的。本研究的目的是比较经裂孔和肋间胸腔引流的短期结果。
这是一项观察性回顾性队列研究。对接受杂交Ivor Lewis食管切除术的患者的两种胸腔引流方法进行了比较。将连接到真空袋的经裂孔引流治疗的患者与连接到水封和吸引装置的传统肋间引流治疗的历史队列患者进行比较。记录术后发病率、总引流量和每日引流量、血清白蛋白水平以及按需给予的扑热息痛和酮咯酸的总剂量。
2014年1月至2016年12月期间，50例采用经裂孔引流和50例采用肋间引流的患者符合纳入本研究的标准。两组的人口统计学和临床病理变量相似。术后并发症发生率无统计学显著差异。两组的总引流量和血清白蛋白水平相似。经裂孔引流患者的酮咯酸总剂量显著降低（P < .001）。
连接便携式真空系统的经裂孔胸腔引流可在杂交Ivor Lewis食管切除术后安全替代肋间引流。它有可能减轻术后疼痛和减少非甾体类抗炎药的使用，并促进术后恢复。
