多槽硅胶引流导管在微创胸外科的临床应用

Clinical application of multi-channel silicone drains in minimally invasive thoracic surgery

摘要:

目的 探讨多槽硅胶引流导管在微创胸外科手术中的可行性，评价术后应用该引流系统的优越性。 方法 选取2016 年1 月-2017 年9 月该院行胸腔镜手术的患者160 例，根据术后应用引流管不同，将其分为 负压组（应用多槽硅胶引流导管+ 自带负压硅胶球囊）和对照组（传统胸管+ 水封瓶），每组各80 例。比较 两组术后24 h 胸腔引流量、总引流量、拔管时间、术后胸穿次数、术后住院时间、术后第1 天与第3 天疼痛 程度（NRS 数字分级法）及术后胸腔出现活动性出血引流效果。结果 两组总引流量比较，差异无统计学意 义（P >0.05）；负压组术后24 h 胸腔引流量升高、拔管时间缩短、胸穿次数减少、术后住院时间缩短及疼痛评 分降低，负压组优于对照组（P <0.05）。负压组2 例48 h 时、对照组2 例24 h 时因活动性出血而再次手术止血。 结论 多槽硅胶引流导管临床应用有一定优势，但因引流槽较细、有活动性出血时易堵塞而形成凝固性血胸， 故需把握不同引流装置的指征。

Abstract:

Objective To investigate the feasibility of Multi-channel silicone drains in minimally invasive thoracic surgery. Methods Totally 160 patients undergoing video-assisted thoracoscopic surgery from January 2016 to September 2017 were involved in this study. Two types of drainage tube were utilized (n = 80): Multi-channel silicone drainage plus silica gel negative-pressure suction, and traditional chest tube plus water seal system. First 24-hour drainage volume post-surgery, total volume of drainage, duration of time of tube, number of thoracentesis after surgery, postoperative hospital stay, levels of pain on postoperative day 1 and 2 (Numeric Rating Scale, NRS), and efficiency of drainage when bleeding were recorded. Results No distinct difference in total volume of drainage was identified between 2 groups (P > 0.05). Patients in negative pressure group experienced significant decrease of duration of tube, number of thoracentesis after surgery, postoperative hospital stay, and levels of pain on postoperative day 1 and 2 and increase of first 24-hour drainage when compared with those in control group (P < 0.05). Two cases in both negative pressure group and control group underwent unexpected surgery due to internal bleeding. Conclusions Multi-channel silicone drainage exerts clinical advantages with certain indications.