Petrache Ioan Adrian, Oancea Cristian, Hasan Elisei Moise, Neagoe Octavian Constantin, Tudorache Emanuela, Ionica Mihaela, Burlacu Ovidiu Nicolae
First Discipline of Surgical Semiology, First Department of Surgery, "Victor Babeș" University of Medicine and Pharmacy Timișoara, Eftimie Murgu Square No. 2, 300041 Timișoara, Romania.
Clinic of Thoracic Surgery, Emergency Clinical Municipal Hospital Timișoara, Gheorghe Dima Street No. 5, 300079 Timișoara, Romania.
J Pers Med. 2021 Oct 6;11(10):1007. doi: 10.3390/jpm11101007.
Chronic post-thoracotomy pain syndrome (PTPS) is a very common and uncomfortable complication, occurring frequently after thoracic operations, leading to the necessity of further medication and hospitalizations. One important risk factor in developing chronic pain is the chest closure technique, which can lead to chronic intercostal nerve damage. This study proposes an alternative nerve-sparring closure technique to standard peri-costal sutures, aimed toward minimizing the risk of chronic pain in selected patients.
We performed a prospective randomized study on 311 patients operated for various thoracic pathology over a period of 12 months, evaluating incision types, chest closure technique, and number of drains with drainage duration. The patients were divided into three groups: peri-costal (PC), proposed extra-costal (EC), and simple (SC) suture, respectively. Pain was measured on day 1, 2, 5, 7, and at 6 months post-operatively using the Visual Analogic Scale.
No significant differences in pain level were recorded in the first two post-operative days between the PC and EC groups. However, a significant decrease in pain level was observed on day 5 and at 6 months post-operatively, with a mean level of 3.5 ± 1.8, 1.2 ± 1 for the EC group compared to a mean value of 5.3 ± 1.6, 3.2 ± 1.5, respectively. No significant differences were observed regarding other evaluated variables.
The lower recorded pain scores in patients with extra-costal chest closure are a strong argument to use this technique. Its ease of use is similar to the classic peri-costal closure, and the time needed to perform it is not significantly increased. The association of this technique with less invasive procedures and short drainage duration limits chronic post-operative pain. This procedure may represent an option for decreasing healthcare costs associated with the management of PTPS.
慢性开胸术后疼痛综合征（PTPS）是一种非常常见且令人不适的并发症，常在胸部手术后频繁发生，导致需要进一步用药和住院治疗。慢性疼痛发生的一个重要风险因素是胸部闭合技术，这可能导致慢性肋间神经损伤。本研究提出一种替代标准肋间缝合的保留神经闭合技术，旨在将特定患者慢性疼痛的风险降至最低。
我们对311例因各种胸部疾病接受手术的患者进行了为期12个月的前瞻性随机研究，评估切口类型、胸部闭合技术以及引流管数量和引流持续时间。患者分别分为三组：肋间（PC）、提议的肋外（EC）和简单（SC）缝合组。术后第1、2、5、7天以及术后6个月使用视觉模拟量表测量疼痛程度。
PC组和EC组术后前两天的疼痛水平无显著差异。然而，术后第5天和6个月时观察到疼痛水平显著降低，EC组的平均水平分别为3.5±1.8、1.2±1，而PC组的平均值分别为5.3±1.6、3.2±1.5。在其他评估变量方面未观察到显著差异。
肋外胸部闭合患者较低的疼痛评分有力支持了使用该技术。其易用性与经典的肋间闭合相似，并且实施该技术所需的时间没有显著增加。该技术与侵入性较小的手术和较短的引流持续时间相结合，可限制术后慢性疼痛。该手术可能是降低与PTPS管理相关医疗成本的一种选择。
