Xu Haitao, Ren Shuai, She Tianyu, Zhang Jingyu, Zhang Lianguo, Jia Teng, Zhang Qingguang
Department of Thoracic Surgery, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou, 256603, Shandong, People's Republic of China.
BMC Surg. 2021 Apr 30;21(1):223. doi: 10.1186/s12893-021-01220-4.
Due to improvements in operative techniques and medical equipment, video-assisted thoracoscopic surgery has become a mainstay of thoracic surgery. Nevertheless, in multiport thoracoscopic surgery, there have been no substantial advances related to the improvement of the esthetics of the site of the chest tube kept for postoperative drainage of intrathoracic fluid and decompression of air leak after thoracoscopic surgery. Leakage of fluid and air around the site of the chest tube can be extremely bothersome to patients.
From March 2019 to April 2020, we used a modified technique of closing the port site in 67 patients and the traditional method in 51 patients undergoing multiport thoracoscopic surgery due to lung disease or mediastinal disease. We recorded patients' age, gender, body mass index, surgical method, postoperative drainage time, and postoperative complications.The NRS pain scale was used to score the pain in each patient on the day of extubation.The PSAS and the OSAS were used for the assessment of scars one month after surgery.
In the modified technique group, only one patient (1.49%) had pleural effusion leakage, compared with five patients (9.80%) in the traditional method group (P < 0.05). There were no significant differences in the pain of extubating and wound dehiscence between the two groups. However,the incidence rates of wound dehiscence in the modified technique group were lower than in the traditional method group. There were no post-removal pneumothorax and wound infection in either of the groups. Significant differences in the PSAS and OSAS were observed between the groups,where the modified technique group was superior to the traditional method group.
The modified technique of port site closure is a leak-proof method of fixation of the chest tube after multiport thoracoscopic surgery. Moreover, it is effective and preserves the esthetic appearance of the skin.
由于手术技术和医疗设备的改进，电视辅助胸腔镜手术已成为胸外科的主要手术方式。然而，在多端口胸腔镜手术中，术后用于胸腔内液体引流和漏气减压的胸管留置部位的美观改善方面没有实质性进展。胸管周围的液体和空气泄漏对患者来说可能非常困扰。
2019年3月至2020年4月，我们对67例因肺部疾病或纵隔疾病接受多端口胸腔镜手术的患者采用改良的端口关闭技术，对51例患者采用传统方法。我们记录了患者的年龄、性别、体重指数、手术方法、术后引流时间和术后并发症。采用数字疼痛评分量表（NRS）对每位患者拔管当天的疼痛进行评分。采用患者主观美学评分（PSAS）和观察者主观美学评分（OSAS）对术后1个月的瘢痕进行评估。
改良技术组仅1例患者（1.49%）发生胸腔积液渗漏，传统方法组为5例患者（9.80%）（P＜0.05）。两组在拔管疼痛和伤口裂开方面无显著差异。然而，改良技术组的伤口裂开发生率低于传统方法组。两组均未发生拔管后气胸和伤口感染。两组间PSAS和OSAS有显著差异，改良技术组优于传统方法组。
改良的端口关闭技术是多端口胸腔镜手术后胸管固定的一种防漏方法。此外，它有效且能保持皮肤的美观外观。
