胸腔镜手术后采用多孔引流策略是否安全可行？

Is it safe and feasible to use multi-lateral-pores drainage strategy after video-assisted thoracoscopic surgery?

机构信息

Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.

Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.

出版信息

PLoS One. 2024 Nov 22;19(11):e0313176. doi: 10.1371/journal.pone.0313176. eCollection 2024.

DOI:10.1371/journal.pone.0313176

PMID:39576808

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11584125/

Abstract

OBJECTIVES

Evidence-based studies optimizing chest tube management have been conducted to accelerate the recovery process for lung cancer patients after video-assisted thoracoscopic surgery (VATS). This study is to evaluate whether using the multi-lateral pores chest tube can achieve better drainage performance than conventional-lateral-pore drainage.

METHODS

Data from patients undergoing VATS were consecutively collected from September 2023 to June 2024. The groups were randomized into two subgroups, which were multi-lateral-pores drainage group (MDG) and conventional-lateral-pore drainage group (CDG). The primary outcomes included chest drainage performance, and the secondary outcomes included postoperative complications (PPCs).

RESULTS

After screening, 228 patients were randomized into two groups, in which 116 patients in MDG and 112 patients in CDG. The daily drainage volume [199.70 (95%CI: 165.19~~234.99) mL/d vs 149.43 (95%CI: 120.70~~179.21) mL/d, P<0.01] and total drainage volume [342.79 (95%CI: 291.91~~392.63) mL vs 272.68 (95%CI: 225.87~~322.11) mL, P = 0.04] in the MDG was significantly higher that that in the CDG. The drainage duration in the MDG was also less than that in the CDG [36.41 (95%CI: 32.23~~40.72) h vs 51.02 (95%CI: 46.03~~56.38) h, P < 0.01]. The incidence of pleural effusion was lower in the MDG when compared with that in CDG (1.7% vs 9.0%, P = 0.04). No differences were found in the other incidences of chest tube-related PPCs, including pneumothorax (12.0% vs 15.2%, P = 0.15) and subcutaneous emphysema (17.2% vs 17.9%, P = 0.35), however.

CONCLUSIONS

Based on this single-center analysis, multi-lateral pores chest tube provided better drainage performance after VATS.

摘要

目的

已有研究对胸腔镜手术后（VATS）肺癌患者的胸腔引流管管理进行了循证优化，以加速患者康复。本研究旨在评估多侧孔引流管在引流性能方面是否优于传统侧孔引流。

方法

连续收集 2023 年 9 月至 2024 年 6 月 VATS 患者的数据，随机分为多侧孔引流组（MDG）和传统侧孔引流组（CDG）。主要结局为胸腔引流性能，次要结局为术后并发症（PPCs）。

结果

筛选后 228 例患者被随机分为两组，MDG 组 116 例，CDG 组 112 例。MDG 组的日引流量[199.70（95%CI：165.19~~234.99）mL/d 比 149.43（95%CI：120.70~~179.21）mL/d，P<0.01]和总引流量[342.79（95%CI：291.91~~392.63）mL 比 272.68（95%CI：225.87~~322.11）mL，P=0.04]均显著高于 CDG 组。MDG 组引流时间也短于 CDG 组[36.41（95%CI：32.23~~40.72）h 比 51.02（95%CI：46.03~~56.38）h，P<0.01]。MDG 组胸腔积液的发生率低于 CDG 组（1.7%比 9.0%，P=0.04）。两组其他与胸腔引流管相关 PPCs（气胸：12.0%比 15.2%，P=0.15；皮下气肿：17.2%比 17.9%，P=0.35）的发生率无差异。