单门胸腔镜手术后是否需要胸腔小导管引流以达到更好的引流效果?

Ali Abdelraouf, H. Elkhayat, M. Osman, Ahmed Elminshawy
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摘要

背景:由于单门静脉胸腔镜手术(VATS)的高气道位置,一些残留积液不能通过胸管排出,理论上导致住院时间延长。假设单门VATS术后在半胸最依赖部位加置小导管引流,并加胸管,评价单门VATS术后胸管小导管引流的住院价值、疼痛评分及胸部x线片。材料与方法:2019年8月至2020年8月进行的一项前瞻性先导随机试验,将接受单门VATS手术的患者分为两组,a组(胸管加小导管)和B组(仅胸管)。结果:53例患者接受了单门VATS,其中30例符合研究条件,分为两组(男性18例,女性12例)。小导管加胸管组患者的平均年龄为42.07±12.85岁,而仅加胸管组患者的平均年龄为34.93±10.73岁。做了六种不同类型的手术。两组术后疼痛和住院时间几乎相等(p > 0.05)。术后小导管伴胸管即刻胸片残余积液采用小导管抽吸处理,次日上午随访胸片有改善(p < 0.05),仅胸管保守处理,次日上午随访胸片无改善(p > 0.05)。结论:小导管加胸管不会增加疼痛。虽然有一半以上的病例通过小导管抽吸,并在第二天早上的胸部x线随访中有所改善,但这并不一定影响住院时间。
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Do we need a small catheter drainage with chest tube after uniportal video-assisted thoracoscopic surgery for better drainage?
Background: Some of the residual effusion cannot be drained by the chest tube due to the high port position of the uniportal video-assisted thoracoscopic surgery (VATS) which theoretically leads to prolonged hospital stay. Hypothesis that putting an additional small catheter drain at the most depended part of the hemi-thorax together with chest tube after uniportal VATS to evaluate value of small catheter drainage with chest tube after uniportal VATS in hospital stay, pain score and chest x-ray. Materials and Methods: It represents a pilot prospective study randomized trial from August 2019 to August 2020 who had undergone uniportal VATS procedures were divided into two groups as group A (chest tube with small catheter) and group B (chest tube only). Results: Fifty-three patients underwent uniportal VATS only 30 where eligible to the study divided into two equal groups (18 males, 12 females). The mean age of patients in the small catheter with chest tube was 42.07 ± 12.85 years, compared to 34.93 ± 10.73 years in the chest tube only. Six different types of operation was done. Postoperative pain and hospital stays was nearly equal in both groups (p > 0.05). Postoperative residual effusion in immediate chest x-ray in small catheter with chest tube was managed by aspiration from small catheter and show improvement in follow up chest x-ray next morning (p < 0.05) but in chest tube only was management conservatively didn’t show improvement in follow up chest x-ray next morning (p > 0.05). Conclusions: Small catheter with chest tube didn’t add more pain. Although more than half of the cases get aspiration from small catheter and show improvement in follow up chest x-ray next morning, this does not statically affect hospital stay.
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