无胸管单孔全胸腔镜手术在快速康复外科中的临床研究——单中心回顾性分析

doi:10.3760/cma.j.issn.1007-1245.2022.16.009

国际医药卫生导报 ›› 2022, Vol. 28 ›› Issue (16): 2257-2262.DOI: 10.3760/cma.j.issn.1007-1245.2022.16.009

无胸管单孔全胸腔镜手术在快速康复外科中的临床研究——单中心回顾性分析

陈慧勇¹ 李伟玲¹ 万仁平¹ 黄淼龙¹ 王林辉² 刘静听¹ 廖洪亮¹ 甘稳¹

¹汕头大学附属粤北人民医院胸外科，韶关　512026； ²汕头大学附属粤北人民医院病理科，韶关　512026

收稿日期:2022-04-25 出版日期:2022-08-15 发布日期:2022-08-15
通讯作者: 陈慧勇，Email：thyjmthn@163.com
基金资助:
韶关市科技计划项目（200812234534346）；

韶关市卫健局科研项目（Y20220）

Clinical study of uniportal thoracoscopic surgery without chest tube in rapid rehabilitation surgery - single center retrospective analysis

Chen Huiyong¹, Li Weiling¹, Wan Renping¹, Huang Miaolong¹, Wang Linhui², Liu Jingting¹, Liao Hongliang¹, Gan Wen¹

¹Department of Thoracic Surgery, Yuebei People's Hospital, Shantou University, Shaoguan 512026, China; ²Department of Pathology, Yuebei People's Hospital, Shantou University, Shaoguan 512026, China

Received:2022-04-25 Online:2022-08-15 Published:2022-08-15
Contact: Chen Huiyong, Email: thyjmthn@163.com
Supported by:
Shaoguan Science and Technology Project (200812234534346);

Scientific Research Project of Shaoguan Health Bureau (Y20220)

摘要/Abstract

摘要： 目的　纳入接受单孔胸腔镜手术后不留置胸管与常规留置胸管的患者，比较两组术后气胸发生率、胸腔积液、肺不张、皮下气肿、切口渗液情况、数字评定量表（NRS）评分、术后平均住院日，从而对两组的安全性及有效性进行评估，以期对部分接受单孔胸腔镜术后不置胸管策略提供证据支持。方法　回顾分析2019年1月1日至2020年11月1日粤北人民医院胸外科行全身麻醉双腔气管插管下胸科手术共1 480例，筛选出单孔胸腔镜肺楔形切除、肺大泡切除及纵隔肿瘤切除患者112例，再次经过纳入排除标准筛选后共73例，分为无胸管组34例（术中经胸管排气水检测无漏气直接缝合切口，不放置引流管）和常规胸管组39例（术中在手术切口肋间留置22号胸腔引流管），对术中转多孔或中转开胸手术、术后并发症、疼痛评分、术后平均住院日进行分析。计量资料采用Wilcoxon秩和检验，计数资料采用χ²检验。结果　两组患者年龄、性别、病种分布比较，差异均无统计学意义（均P>0.05）。所有患者无术中中转开胸或多孔手术；两组患者手术时间、术中出血量、术后第2天NRS评分比较，差异均无统计学意义（均P>0.05）；无胸管组和常规胸管组患者术后第1天NRS评分［2分：38.2%（13/34）比7.7%（3/39）、3分：52.9%（18/34）比56.4%（22/39）、4分：8.8%（3/34）比35.9%（14/39）］、术后住院时间［0 d：0.0%（0/34）比7.7（3/39）、1 d：38.2%（13/34）比15.4%（6/39）、2 d：58.8%（20/34）比48.7%（19/39）、3 d：2.9%（1/34）比17.9%（7/39）、4 d：0.0%（0/34）比10.3%（4/39）］比较，差异均有统计学意义（均P<0.05）。无胸管组并发症发生率为50.0%（17/34），与常规胸管组51.3%（20/39）比较，差异无统计学意义（χ²=0.012，P=0.913）。结论　无胸管单孔胸腔镜对于选择性肺楔形切除、肺大泡切除及纵隔肿瘤切除安全、可行，有助于术后快速康复，减轻患者疼痛及缩短术后住院时间。

关键词: 电视胸腔镜手术, 单孔, 胸腔引流管, 快速康复

Abstract: Objective　To compare the incidences of pneumothorax, pleural effusion, atelectasis, subcutaneous emphysema, and incision effusion, score of Numerical Rating Scale (NRS), and average postoperative hospital stay between the patients who underwent uniportal thoracoscopic surgery without chest tube indwelling and with conventional chest tube indwelling, so as to evaluate the safety and effectiveness of the two groups, and to provide evidence support for some patients who receive uniportal thoracoscopic surgery without chest tube. Methods　From January 1, 2019 to November 1, 2020, a total of 1 480 cases of thoracic surgery under general anesthesia and double-lumen endotracheal intubation in Yuebei People's Hospital were retrospectively analyzed, and 112 cases of uniportal thoracoscopic pulmonary wedge resection, pulmonary bulla resection, and mediastinal tumor resection were selected. After screening again, 73 cases were divided into a tube-free group and a conventional chest tube group. In the 34 patients of the tube-free group, the incision was directly sutured without drainage tube indwelling after the chest tube exhaust water detection showed no air leakage during the operation; in the 39 patients of the conventional chest tube group, No. 22 thoracic drainage tube was indwelled in the intercostal incision during the operation. The incidence of transferring to porous thoracoscopic surgery or thoracotomy, complications, pain score, and average postoperative hospital stay were analyzed. Wilcoxon rank sum test was used for the measurement data, and χ² test was used for the count data. Results　There were no statistically significant differences in the age, gender, and disease distribution between the two groups (all P>0.05). None of the patients in the two groups were transferred to porous thoracoscopic surgery or thoracotomy. There were no statistically significant differences in the operation time, intraoperative blood loss, and NRS score on the second day after the operation between the two groups (all P>0.05). There were statistically significant differences in the NRS score [2 points: 38.2% (13/34) vs. 7.7% (3/39), 3 points: 52.9% (18/34) vs. 56.4% (22/39), 4 points: 8.8% (3/34) vs. 35.9% (14/39)] on the first day after the operation and postoperative hospital stay [0 d: 0.0% (0/34) vs. 7.7 (3/39), 1 d: 38.2% (13/34) vs. 15.4% (6/39), 2 d: 58.8% (20/34) vs. 48.7% (19/39), 3 d: 2.9% (1/34) vs. 17.9% (7/39), 4 d: 0.0% (0/34) vs. 10.3% (4/39)] between the tube-free group and the conventional chest tube group (both P<0.05). The incidence of complications in the tube-free group was 50.0% (17/34), without statistically significant difference compared with 51.3% (20/39) in the conventional chest tube group (χ²=0.012, P=0.913). Conclusion　Uniportal thoracoscopy without chest tube is safe and feasible for selective pulmonary wedge resection, pulmonary bullae resection, and mediastinal tumor resection, which is helpful for quick postoperative recovery, pain relief, and shortening hospital stay.

Key words: Video-assisted thoracoscopic surgery, Uniportal, Chest tube, Rapid postoperative recovery

陈慧勇李伟玲万仁平黄淼龙王林辉刘静听廖洪亮甘稳 . 无胸管单孔全胸腔镜手术在快速康复外科中的临床研究——单中心回顾性分析[J]. 国际医药卫生导报, 2022, 28(16): 2257-2262.

Chen Huiyon, Li Weiling, Wan Renping, Huang Miaolong, Wang Linhui, Liu Jingting, Liao Hongliang, Gan Wen. Clinical study of uniportal thoracoscopic surgery without chest tube in rapid rehabilitation surgery - single center retrospective analysis [J]. International Medicine and Health Guidance News, 2022, 28(16): 2257-2262.

参考文献

[1] Luckraz H, Rammohan KS, Phillips M, et al. Is an intercostal chest drain necessary after video-assisted thoracoscopic (VATS) lung biopsy?[J].Ann Thorac Surg,2007,84(1):237-239. DOI:10.1016/j.athoracsur.2007. 03.007.
[2] Liu J, Cui F, Li S, et al. Nonintubated video-assisted thoracoscopic surgery under epidural anesthesia compared with conventional anesthetic option: a randomized control study[J].Surg Innov,2015,22(2):123-130. DOI:10.1177/1553350614531662.
[3] Guo Z, Shao W, Yin W, et al. Analysis of feasibility and safety of complete video-assisted thoracoscopic resection of anatomic pulmonary segments under non-intubated anesthesia[J].J Thorac Dis,2014,6(1):37-44. DOI:10.3978/j.issn.2072-1439.2014.01.06.
[4] Ueda K, Tanaka T, Jinbo M, et al. Sutureless pneumostasis using polyglycolic acid mesh as artificial pleura during video-assisted major pulmonary resection[J].Ann Thorac Surg,2007,84(6):1858-1861. DOI:10.1016/j.athoracsur. 2007.06.080.
[5] 叶雄,陈刚,唐继鸣,等.胸腔镜微创术后不留置胸腔引流管在快速康复外科中的应用[J].中国胸心血管外科临床杂志,2014,21(1):112-114.
[6] Watanabe A, Watanabe T, Ohsawa H, et al. Avoiding chest tube placement after video-assisted thoracoscopic wedge resection of the lung[J].Eur J Cardiothorac Surg,2004,25(5):872-876. DOI:10.1016/j.ejcts.2004.01.041.
[7] 王福栋,翁鸢,耿纪群,等.单孔胸腔镜手术切口缝合技术改进与效果评价[J].实用医学杂志,2021,37(2):255-259. DOI:10.3969/j.issn.1006-5725.2021.02.024.
[8] Rocco G, Martucci N, La Manna C, et al. Ten-year experience on 644 patients undergoing single-port (uniportal) video-assisted thoracoscopic surgery[J].Ann Thorac Surg,2013,96(2):434-438. DOI:10.1016/j.athoracsur.2013.04.044.
[9] Mier JM, Chavarin A, Izquierdo-Vidal C, et al. A prospective study comparing three-port video-assisted thoracoscopy with the single-incision laparoscopic surgery (SILS) port and instruments for the video thoracoscopic approach: a pilot study[J].Surg Endosc,2013,27(7):2557-2560. DOI:10.1007/s00464-012- 2782-6.
[10] Bjerregaard LS, Jensen K, Petersen RH, et al. Early chest tube removal after video-assisted thoracic surgery lobectomy with serous fluid production up to 500 ml/day[J].Eur J Cardiothorac Surg,2014,45(2):241-246. DOI:10.1093/ejcts/ezt376.
[11] 房树坤. 胸腔镜微创手术在纵隔肿瘤切除术中的临床应用价值[J]. 国际医药卫生导报,2015,21(15):2162-2163. DOI:10.3760/cma.j.issn.1007-1245.2015.15.018.
[12] 谭征,李建华,梁靓,等. 全胸腔镜下治疗小儿纵隔肿瘤[J]. 中华胸心血管外科杂志,2016,32(3):178-179. DOI:10.3760/cma.j.issn.1001-4497.2016.03.014.
[13] 王志超,张合林,刘俊峰,等. 单操作孔全胸腔镜手术治疗纵隔肿瘤43例临床分析[J]. 中华外科杂志,2014,52(5):393-394. DOI:10.3760/cma.j.issn.0529-5815.2014. 05.019.
[14] Miyazaki T, Sakai T, Yamasaki N, et al. Chest tube insertion is one important factor leading to intercostal nerve impairment in thoracic surgery[J].Gen Thorac Cardiovasc Surg,2014,62(1):58-63. DOI:10.1007/s11748-013- 0328-z.
[15] 施庆彤,刁亚利,钱军. 单孔胸腔镜手术联合ERAS理念指导下的呼吸功能锻炼在肺癌围手术期的应用[J]. 中国肺癌杂志,2020,23(8):667-672. DOI:10.3779/j.issn.1009-3419. 2020.101.26.
[16] 孙静,黄涛. 探讨不同胸腔镜手术切除方式治疗肺部小结节的临床疗效比较[J]. 中南医学科学杂志,2020,48(2):131-133. DOI:10.15972/j.cnki.43-1509/r.2020.02.005.
[17] Zhang JT, Tang YC, Lin JT, et al. Prophylactic air-extraction strategy after thoracoscopic wedge resection[J].Thorac Cancer,2018,9(11):1406-1412. DOI:10.1111/1759-7714. 12850.
[18] Gonzalez-Rivas D, Delgado M, Fieira E, et al. Uniportal video-assisted thoracoscopic pneumonectomy[J].J Thorac Dis,2013,5Suppl 3(Suppl 3):S246-S252. DOI:10.3978/j.issn.2072-1439.2013.07.44.
[19] Refai M, Brunelli A, Salati M, et al. The impact of chest tube removal on pain and pulmonary function after pulmonary resection[J].Eur J Cardiothorac Surg,2012,41(4):820-823. DOI:10.1093/ejcts/ezr126.
[20] Rotman JA, Plodkowski AJ, Hayes SA, et al. Postoperative complications after thoracic surgery for lung cancer[J].Clin Imaging,2015,39(5):735-749. DOI:10.1016/j.clinimag.2015.05.013.
[21] Ueda K, Haruki T, Murakami J, et al. No drain after thoracoscopic major lung resection for cancer helps preserve the physical function[J].Ann Thorac Surg,2019,108(2):399-404. DOI:10.1016/j.athoracsur.2019.03.018.

无胸管单孔全胸腔镜手术在快速康复外科中的临床研究——单中心回顾性分析

Clinical study of uniportal thoracoscopic surgery without chest tube in rapid rehabilitation surgery - single center retrospective analysis

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