单操作孔胸腔镜肺癌根治术后胸腔引流管拔除指征的研究

发布时间：2018-04-05 02:33

  本文选题：胸腔镜　切入点：单操作孔　出处：《苏州大学》2015年硕士论文

【摘要】：目的:探讨单操作孔电视胸腔镜(video-assisted thoracoscopic surgery,VATS)肺癌根治术后胸腔引流管的拔除指征。方法:将2012年8月至2014年2月苏州大学附属第一医院胸外科168例行单操作孔VATS肺癌根治术的患者随机分为A、B、C三组,分别以胸腔引流液量≤150 ml/d、300 ml/d、450 ml/d为拔管指征。所有患者术后24 h行胸部X线检查肺复张及胸腔积液情况。观察和记录引流液量及性状。记录患者体温变化,行血常规及血生化检查。根据改良的视觉模拟疼痛评分法,大于4分者根据情况予以肌注盐酸哌替啶1 mg/kg,患者出院后随访1周。观察记录3组术后引流管拔除时间、术后住院时间、术后VAS疼痛评分、术后止痛药物用量、术后并发症(包括发热、呼吸困难、心律失常、皮下气肿、胸膜残腔、胸腔积液)的发生率、胸腔穿刺率,再次置管率。结果:A、B、C三组的术后病理类型均包括鳞癌、腺癌和其他非小细胞肺癌,差异无统计学意义(p=0.957)。三组的淋巴结清扫数目分别为11.9±1.3,12.4±1.2和12.6±1.0颗,差异无统计学意义(p=0.844)。三组患者还分别比较了平均年龄、性别、手术时间以及胸管数目,结果显示差异均无统计学意义(P0.05)。B、C组患者的术后引流时间较A组患者的短,且差异有统计学意义(P0.05);C组患者的术后引流时间较B组更短,差异有统计学意义(P=0.036)。B、C两组的术后住院时间分别为4.8±1.1、4.3±1.2天,差异无统计学意义(P=0.066)。A、B、C三组的平均盐酸哌替啶用量分别为370.5±42.6、248.9±33.3、226.1±32.7 mg,A组用量较B、C组大,差异有统计学意义(P0.05)。B组和C组在VAS总评分方面的差异无统计学意义(P0.05),但A组的VAS总评分大于B、C组(P0.05)。全组患者共有13例发生胸腔积液,其中2例来自B组且1例需行胸腔穿刺抽液,另外11例均来自C组,其中10例需行胸腔穿刺或者再次置管引流。C组胸腔穿刺的患者数目明显多于A、B组,且差异有统计学意义(P0.05),三组之间胸腔再次置管的差别无统计学意义(P0.05)。结论:以胸腔引流液量阈值为300 ml/d时拔除引流管与传统的以胸腔引流液量阈值为150 ml/d时拔除引流管相比,可明显缩短患者引流时间、术后住院时间、降低患者术后住院费用、减低患者的疼痛感觉,且并不增加并发症及胸腔穿刺的发生率,而以胸腔引流液量阈值为450 ml/d时拔除引流管也是可行的,但可能会增加患者拔管后胸腔积液的发生率及行胸腔穿刺术的风险,安全性有所下降。
[Abstract]:Objective: to investigate the indication of extubation of thoracic drainage tube after video-assisted thoracoscopic Surgeryus (VATS) radical resection of lung cancer.Methods: from August 2012 to February 2014, 168 patients undergoing single hole VATS radical resection of lung cancer in the first affiliated Hospital of Suzhou University were randomly divided into three groups. The drainage volume of thoracic cavity was less than 150ml / d ~ (3) ml / d ~ (#number0#) / d ~ (450) ml/d as the indication of extubation.All patients underwent chest X-ray examination 24 hours after operation of pulmonary reexpansion and pleural effusion.The quantity and characteristics of drainage fluid were observed and recorded.The changes of body temperature, blood routine and blood biochemical examination were recorded.According to the improved visual analogue pain score, those who scored more than 4 were given 1 mg / kg pethidine hydrochloride intramuscularly. The patients were followed up for 1 week after discharge.Postoperative drainage tube extraction time, postoperative hospitalization time, postoperative VAS pain score, postoperative analgesic dosage, postoperative complications (including fever, dyspnea, arrhythmia, subcutaneous emphysema, pleural cavity) were observed and recorded.The incidence of pleural effusion, the rate of thorax puncture, and the rate of re-catheterization.Results the postoperative pathological types of the three groups included squamous cell carcinoma, adenocarcinoma and other non-small cell lung cancer (NSCLC). There was no significant difference between the three groups (p0. 957).The number of lymph node dissection in the three groups were 11.9 卤1.3, 12.4 卤1.2 and 12.6 卤1.0, respectively. The difference was not statistically significant.The mean age, sex, operation time and the number of thoracic ducts were also compared among the three groups. The results showed that there was no significant difference in postoperative drainage time between group A and group A.The postoperative drainage time in group P0.05 was shorter than that in group B, and the postoperative hospital stay was 4.8 卤1.1 卤1.2 days.宸�寮傛棤缁熻�″�︽剰涔�(P=0.066).A,B,C涓夌粍鐨勫钩鍧囩洂閰稿搶鏇垮暥鐢ㄩ噺鍒嗗埆涓，

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