Yu Pingwen, Stamenovic Davor, Fernando Hiran C, Liu Hongxu
Department of Thoracic Surgery, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital & Institute, Shenyang, China.
Department of Thoracic Surgery, Center for Thoracic Diseases, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany.
J Thorac Dis. 2024 Jul 30;16(7):4597-4606. doi: 10.21037/jtd-24-925. Epub 2024 Jul 26.
There are no standard guidelines regarding the number and size of chest tubes that should be selected after thoracic surgery. This study aimed to evaluate the effects of adopting a drainage strategy with bi-pigtail catheters (BPCs) on patients undergoing lobectomy by uniportal video-assisted thoracic surgery (VATS).
A retrospective study was performed of patients undergoing uniportal lobectomy at the Department of Thoracic Surgery of the Cancer Hospital of Dalian University of Technology between August 2021 and August 2022. The patients were divided into the following two groups according to the drainage strategy adopted: (I) a traditional chest tube (TCT) group; and (II) a BPC group. The outcomes measured included postoperative complications, as measured by the Clavien-Dindo method, and the visual analogue scale (VAS) pain scores of the patients after surgery.
In total, 868 patients underwent lung resection during the study period, after exclusion, the data of 470 patients who underwent uniport lobectomy were reviewed (235 in the TCT group, and 235 in the BPC group). There were no statistically significant differences between the two groups in terms of baseline data (P>0.05). The incidence of postoperative complications (7.7% . 19.1%) and postoperative VAS pain scores at 7-24 hours (3.3±1.0 . 3.7±1.5) and 25-48 hours (3.1±0.8 . 3.6±1.5) were significantly lower in the BPC group than the TCT group (all P<0.001). Additionally, the postoperative length of stay (4.6±1.5 . 5.4±4.5 days) and the collapse rate of the residual lung (19.2%±9.1% . 20.9%±9.6%) of the BPC group were better than those of the TCT group (P<0.05). The results of univariable and multivariable analyses showed that a drainage strategy with a TCT was an independent risk factor for decreased postoperative complications, and reduced moderate or severe pain scores at 7-24 and 25-48 hours after surgery.
Our drainage strategy with BPCs decreased the incidence of postoperative complications and alleviated the postoperative pain of patients undergoing lobectomy by uniportal VATS and is safe and feasible.
对于胸外科手术后应选择的胸管数量和尺寸，尚无标准指南。本研究旨在评估采用双猪尾导管（BPC）引流策略对单孔电视辅助胸腔镜手术（VATS）下肺叶切除术患者的影响。
对2021年8月至2022年8月在大连理工大学附属肿瘤医院胸外科接受单孔肺叶切除术的患者进行回顾性研究。根据采用的引流策略将患者分为以下两组：（I）传统胸管（TCT）组；（II）BPC组。测量的结果包括采用Clavien-Dindo方法衡量的术后并发症，以及患者术后的视觉模拟量表（VAS）疼痛评分。
在研究期间，共有868例患者接受了肺切除术，排除后，对470例行单孔肺叶切除术患者的数据进行了回顾（TCT组235例，BPC组235例）。两组基线数据差异无统计学意义（P>0.05）。BPC组术后并发症发生率（7.7%对19.1%）以及术后7至24小时（3.3±1.0对3.7±1.5）和25至48小时（3.1±0.8对3.6±1.5）的VAS疼痛评分均显著低于TCT组（均P<0.001）。此外，BPC组术后住院时间（4.6±1.5对5.4±4.5天）和残余肺萎陷率（19.2%±9.1%对20.9%±9.6%）均优于TCT组（P<0.05）。单因素和多因素分析结果显示，采用TCT的引流策略是术后并发症减少、术后7至24小时和25至48小时中度或重度疼痛评分降低的独立危险因素。
我们采用BPC的引流策略降低了单孔VATS肺叶切除术患者的术后并发症发生率，减轻了术后疼痛，且安全可行。
