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目的探讨胸腔镜肺叶切除术(video-assisted thoracic surgery,VATS)后应用16 F尿管行胸腔引流是否增加了术后并发症及其较28 F引流管的临床优势。方法 2015年10~12月四川大学华西医院胸外科连续收治102例肺癌行VATS肺叶切除术患者,分别应用16 F尿管(16 F组,49例)和28 F引流管(28 F组,53例)行胸腔引流,分析术后胸腔积气、积液、30 d后胸腔积液,术后住院时间、引流量、引流持续时间、术后引流管拆线时间、视觉疼痛评分(VAS)评分和舒适度及引流口愈合情况。结果 16 F组胸腔引流总量少于28 F组,差异有统计学意义[(587.3±323.7)ml vs.(824.1±444.3)ml,P=0.000)]。两组患者术后肺部并发症发生率(16 F组,30.6%;28 F组,28.3%)差异无统计学意义(P=0.102)。16 F组皮下气肿发生率(60.0%)显著高于28 F组(6.7%,P=0.011),16 F组再置管率(2.0%)低于28 F组(5.7%,P=0.048)。16 F组引流时间和术后住院时间[(54.2±28.6)h,(4.2±1.4)d)]均显著短于28 F组[(95.6±65.5)h,(6.5±3.0)d,P=0.000,P=0.000)]。16 F组引流管口拆线时间显著短于28 F组[(8.1±1.2)d vs.(14.3±4.1)d,P=0.033]。而16 F组引流管口Ⅰ级愈合率(100.0%)显著高于28 F组(58.5%,P=0.014)。结论胸腔镜肺叶切除术后用16 F尿管行胸腔引流可行,且有助于患者快速康复。
Objective To investigate whether postoperative thoracic drainage with 16F catheter after video-assisted thoracic surgery (VATS) increases postoperative complications and its clinical advantage over 28 F drainage tube. Methods A total of 102 consecutive patients undergoing VATS lobectomy for lung cancer were enrolled in the Department of Thoracic Surgery, West China Hospital, Sichuan University from January 2015 to December 2015. The patients were enrolled in this study. Sixteen F catheters (group F, 49) and 28 F drainage tube Cases were performed thoracic drainage, pleural effusion, effusion after 30 days, pleural effusion after 30 days, postoperative hospital stay, drainage, duration of drainage, postoperative drainage catheter removal time, visual acuity score (VAS) And comfort and drainage port healing. Results The total amount of chest drainage in group 16 F was less than that in group 28 F, with a significant difference (587.3 ± 323.7 ml vs 824.1 ± 444.3 ml, P = 0.000). There was no significant difference in the incidence of postoperative pulmonary complications between the two groups (16 F group, 30.6%; 28 F group, 28.3%) (P = 0.102). The incidence of subcutaneous emphysema in group 16F (60.0%) was significantly higher than that in group 28F (6.7%, P = 0.011), and that in group 16F was lower than that in group 28F (5.7%, P = 0.048 ). The drainage time and hospital stay in group 16F were significantly shorter than those in group 28F [(95.6 ± 65.5) h and (6.5 ± 3.0) days, respectively, (54.2 ± 28.6 and 4.2 ± 1.4 d, P = 0.000, P = 0.000)]. The drainage time of drainage tube in group 16F was significantly shorter than that in group 28F [(8.1 ± 1.2) d vs. (14.3 ± 4.1) d, P = 0.033]. However, grade Ⅰ drainage rate in group D was significantly higher than that in group 28F (58.5%, P = 0.014). Conclusions Thoracoscopic lobectomy with thoracic drainage with 16 F catheter is feasible and can help patients recover quickly.