Russo L, Wiechmann R J, Magovern J A, Szydlowski G W, Mack M J, Naunheim K S, Landreneau R J
Allegheny General Hospital Campus, Allegheny University of the Health Sciences, Pittsburgh, Pennsylvania 15212, USA.
Ann Thorac Surg. 1998 Nov;66(5):1751-4. doi: 10.1016/s0003-4975(98)00946-1.
Traditional management of chest tubes after a wedge resection of peripheral pulmonary tissue often lasts several days. We evaluated the safety and efficacy of early chest tube removal in the recovery room after uncomplicated video-assisted thoracoscopic surgical wedge resections of the lung.
From December 1995 to July 1997, 59 patients underwent video-assisted thoracoscopic surgical wedge resection for indeterminate pulmonary nodules (n = 33) or interstitial lung disease (n = 26). We prospectively evaluated early chest tube removal in the last 33 patients; 18 patients with nodules and 15 with interstitial lung disease. Patients who were in the early removal group had chest tubes removed within 90 minutes of the surgical procedure. Criteria for early removal were established and met before chest tube removal. There was no difference between groups with respect to age, sex, comorbidities, or pathologic evaluation of resection specimens.
Ninety-four percent (31 of 33) of patients considered for early chest tube removal met criteria for immediate tube removal. Air leak and excessive drainage prohibited early removal in 2 patients. Patients who were managed traditionally averaged 3.3 days with chest tubes--1.8 days on suction, 1.3 days on water seal. Patients who had early removal of their chest tubes had a shorter postoperative stay (2.0+/-1.0 versus 3.9+/-2.1 days, p = 0.001) and fewer chest roentgenograms (2.8+/-2.1 versus 5.1+/-2.0, p = 0.001). There were no differences in complications including small pneumothoraces (5 in the early removal group, 7 in the traditional management group), which were managed with observation alone. Total narcotic requirements were greater in the traditional management group (54+/-44.8 versus 24.6+/-22.9 morphine milligram equivalents, p = 0.005).
Early chest tube removal after video-assisted thoracoscopic surgical wedge resection of peripheral pulmonary tissue appears to be a safe and cost-effective practice if strict criteria for removal are met.
在外周肺组织楔形切除术后，传统的胸管管理通常持续数天。我们评估了在无并发症的电视辅助胸腔镜手术肺楔形切除术后在恢复室早期拔除胸管的安全性和有效性。
1995年12月至1997年7月，59例患者接受了电视辅助胸腔镜手术楔形切除术，用于处理不明肺结节（n = 33）或间质性肺疾病（n = 26）。我们前瞻性地评估了最后33例患者的早期胸管拔除情况；其中18例为结节患者，15例为间质性肺疾病患者。早期拔除组的患者在手术过程后90分钟内拔除胸管。在拔除胸管之前制定并满足了早期拔除的标准。两组在年龄、性别、合并症或切除标本的病理评估方面没有差异。
考虑早期拔除胸管的患者中有94%（33例中的31例）符合立即拔除胸管的标准。2例患者因漏气和引流过多而无法早期拔除。传统管理的患者胸管平均留置3.3天——持续吸引1.8天，水封1.3天。早期拔除胸管的患者术后住院时间较短（2.0±1.0天对3.9±2.1天，p = 0.001），胸部X线检查次数较少（2.8±2.1次对5.1±2.0次，p = 0.001）。并发症方面没有差异，包括小气胸（早期拔除组5例，传统管理组7例），均仅通过观察进行处理。传统管理组的总麻醉需求量更大（54±44.8对24.6±22.9吗啡毫克当量，p = 0.005）。
如果满足严格的拔除标准，电视辅助胸腔镜手术外周肺组织楔形切除术后早期拔除胸管似乎是一种安全且具有成本效益的做法。
