Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan.
Department of Surgery, Hitachi, Ltd., Hitachinaka General Hospital, Hitachinaka, Ibaraki, Japan.
J Cardiothorac Surg. 2022 Aug 24;17(1):200. doi: 10.1186/s13019-022-01953-0.
Mediastinoscope and laparoscope-assisted esophagectomy for esophageal cancer occasionally causes postoperative accumulation of pleural effusion despite the preservation of the mediastinal pleura. Transhiatal chest drainage has been reported to be useful for thoracic esophagectomy; however, its use in mediastinoscope and laparoscope-assisted esophagectomy remains unelucidated. This study aimed to evaluate the effectiveness and safety of transhiatal chest drainage in mediastinoscope and laparoscope-assisted esophagectomy.
This retrospective study included patients who underwent mediastinoscope and laparoscope-assisted esophagectomy for esophageal cancer from 2018 to 2021. Transhiatal chest drainage involved the insertion of a 19-Fr Blake® drain from the abdomen to the left thoracic cavity through the hiatus. We assessed its effectiveness and safety by the daily drainage output, accumulation of postoperative pleural effusion, frequency of postoperative thoracentesis, and other complications. The drainage group comprising 24 patients was compared with the non-drainage group comprising 13 patients, in whom a transhiatal chest drainage tube was not placed during mediastinoscope and laparoscope-assisted esophagectomy.
The median daily output of the transhiatal chest drainage was 230 mL on day 1, 385 mL on day 2, and 313 mL on day 3. The number of patients with postoperative pleural effusion was significantly reduced from 10/13 (76.9%) in the non-drainage group to 4/24 (16.7%) in the drainage group (p = 0.001). The frequency of thoracentesis in the drainage group was significantly lower than that in the non-drainage group (p = 0.002). There were no significant differences in the occurrence of other postoperative complications.
Transhiatal chest drainage could evacuate pleural effusion effectively and safely after mediastinoscope and laparoscope-assisted esophagectomy.
纵隔镜和腹腔镜辅助食管癌切除术有时会导致纵隔胸膜保留，但仍会发生术后胸腔积液积聚。经食管裂孔胸腔引流已被报道对胸段食管癌切除术有效；然而，其在纵隔镜和腹腔镜辅助食管癌切除术中的应用仍不清楚。本研究旨在评估纵隔镜和腹腔镜辅助食管癌切除术后经食管裂孔胸腔引流的有效性和安全性。
本回顾性研究纳入了 2018 年至 2021 年期间接受纵隔镜和腹腔镜辅助食管癌切除术的患者。经食管裂孔胸腔引流是指通过横膈膜将一根 19Fr Blake®引流管从腹部插入左胸腔。我们通过每天的引流量、术后胸腔积液积聚、术后胸腔穿刺的频率和其他并发症来评估其有效性和安全性。引流组包括 24 例患者，与非引流组（13 例）进行比较，在纵隔镜和腹腔镜辅助食管癌切除术中未放置经食管裂孔胸腔引流管。
纵隔镜和腹腔镜辅助食管癌切除术后第一天的经食管裂孔胸腔引流中位日输出量为 230ml，第二天为 385ml，第三天为 313ml。与非引流组（10/13，76.9%）相比，引流组术后胸腔积液患者的数量明显减少（4/24，16.7%）（p=0.001）。引流组胸腔穿刺的频率明显低于非引流组（p=0.002）。其他术后并发症的发生率无显著差异。
纵隔镜和腹腔镜辅助食管癌切除术后经食管裂孔胸腔引流可有效、安全地排出胸腔积液。
