肺切除术后改良胸管放置与常规放置的随机临床试验

SCI

21 May 2023

Randomized Trial of Modified Chest tube Placement Versus Routine Placement After Lung Resection

(ATS, IF: 5.102)

Yun Tianxiang,Zhang Yaoyun,Liu Ao et al. Randomized Trial of Modified Chest tube Placement Versus Routine Placement After Lung Resection.[J] .Ann Thorac Surg, 2023, undefined: undefined.

BACKGROUND 背景  

Chest tube placement following pulmonary resection is usually considered a mandatory procedure. However, peritubular leakage of pleural fluid and intrathoracic air is frequent after surgery. Therefore, we separated the chest tube from the intercostal space as a modified placement strategy.

肺切除术后放置胸管通常被认为是一项强制性步骤。然而，术后经常发生胸管周围胸腔积液和胸腔内空气的渗漏。因此，我们将胸管与肋间隙分开作为一种改良的放置策略。

METHODS 方法  

Patients undergoing robotic and video-assisted lung resection were enrolled into this sudy at our medical center between February 2021 to August 2021. All patients were randomly divided into either the modified group (n=98) or routine group (n=101). The incidence of peritubular leakage of pleural fluid and peritubular air leaking or entering after surgery were the primary endpoints of the study.

于2021年2月至2021年8月在我们的医疗中心接受机器人和电视辅助胸腔镜下肺切除术的患者纳入本研究。所有患者随机分为改良组(n=98)和常规组(n=101)。研究的主要终点是胸管周围胸腔积液渗漏和术后胸管周围空气进出的发生。

RESULTS 结果  

A total of 199 patients were randomized. Patients in modified group had a lower incidence of peritubular leakage of pleural fluid (after surgery: 39.6% vs. 18.4%, p=0.007; after chest tube removal: 26.7% vs. 11.2%, P=0.005), lower incidence of peritubular air leaking or entering (14.9% vs. 5.1%, P=0.022), and fewer dressing changes (5.02±2.30 vs. 3.48±0.94, P＜0.001). In patients undergoing lobectomy and segmentectomy, the type of chest tube placement was associated with the severity of peritubular pleural fluid leakage (P＜0.05).

199例患者被随机分组。改良组患者胸管周围胸水渗漏发生率较低(术后：39.6% vs. 18.4%，p=0.007；胸管拔除后：26.7% vs. 11.2%，p=0.005)，管周空气进出的发生率较低(14.9% vs. 5.1%，p=0.022)，换药次数较少(5.02±2.30 vs. 3.48±0.94, p<0.001)。行肺叶和肺段切除术的患者，置管方式与管周胸腔积液漏严重程度相关(p<0.05)。

CONCLUSION 结论  

The modified chest tube placement was safe and had better clinical efficacy than the routine type. The reduction of postoperative peritubular leakage of pleural fluid resulted in better wound recovery. This modified strategy should be popularized, especially in patients undergoing pulmonary lobectomy or segmentectomy.

改良胸管置入术安全可靠，临床疗效优于常规置管。术后管周胸水渗漏减少，伤口恢复较好。这种改良的策略应该推广，特别是在接受肺叶切除术或肺段切除术的患者中。

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