CAJ | 학술논문

背景与目的微创胸外科术后管理仍延用开放术后的方式，尤其是胸腔引流管的术后管理，本研究探讨胸腔镜（video-assisted thoracic surgery, VATS）肺叶切除术后应用胸腔引流管（16 F）对切口愈合延迟的影响，是否因引流管管径小而导致相关并发症的增多。方法选取2014年2月-2014年5月四川大学华西医院连续收治的163例肺癌行VATS肺叶切除术，分别应用引流管28 F（75例）和16 F（88例），分析术后胸腔积气、积液、皮下气肿、引流管持续时间、术后住院日、术后引流管拆线时间和切口愈合率。结果平均引流量和心律失常发生率在16 F组[(365±106) mL,14.67%]明显低于28 F组[(665±217) mL,4.5%]（P=0.030,1,P=0.047）；术后胸腔积气、积液和皮下气肿在28 F组发生率（4.00%,0.0%,7.50%）与16 F组（4.50%,3.41%,6.82%）均无统计学差异（P<0.999,P=0.253,P=0.789）；引流管持续时间及术后平均住院日在16F组[(22.1±11.8) h,(4.23±0.05) d]与28 F组[(28.4±16.12) h,(4.57±0.16) d]均无统计学差异（P=0.12,P=0.078）；引流管拆线时间在16 F组（7.05±2.11）d明显短于28 F组（14.33±3.87）d（P=0.034）；切口一级愈合率在16 F组（95.45%）明显高于28 F组（77.73%）（P=0.039）。结论胸腔镜肺叶切除术后16 F和28 F引流临床效果相当，而16 F有助于引流管口快速愈合。
배경여목적미창흉외과술후관리잉연용개방술후적방식，우기시흉강인류관적술후관리，본연구탐토흉강경（video-assisted thoracic surgery, VATS）폐협절제술후응용흉강인류관（16 F）대절구유합연지적영향，시부인인류관관경소이도치상관병발증적증다。방법선취2014년2월-2014년5월사천대학화서의원련속수치적163례폐암행VATS폐협절제술，분별응용인류관28 F（75례）화16 F（88례），분석술후흉강적기、적액、피하기종、인류관지속시간、술후주원일、술후인류관탁선시간화절구유합솔。결과평균인류량화심률실상발생솔재16 F조[(365±106) mL,14.67%]명현저우28 F조[(665±217) mL,4.5%]（P=0.030,1,P=0.047）；술후흉강적기、적액화피하기종재28 F조발생솔（4.00%,0.0%,7.50%）여16 F조（4.50%,3.41%,6.82%）균무통계학차이（P<0.999,P=0.253,P=0.789）；인류관지속시간급술후평균주원일재16F조[(22.1±11.8) h,(4.23±0.05) d]여28 F조[(28.4±16.12) h,(4.57±0.16) d]균무통계학차이（P=0.12,P=0.078）；인류관탁선시간재16 F조（7.05±2.11）d명현단우28 F조（14.33±3.87）d（P=0.034）；절구일급유합솔재16 F조（95.45%）명현고우28 F조（77.73%）（P=0.039）。결론흉강경폐협절제술후16 F화28 F인류림상효과상당，이16 F유조우인류관구쾌속유합。
Background and objective Post-operation management of minimally invasive thoracic surgery is simi-lar to that of open surgery, especially on the drainage tube of the chest. hTe aim of this study is to compare the advantages of us-ing 16 F versus 28 F chest tubes in video-assisted thoracoscopic surgery (VATS) lobectomy of lung cancer.Methods Data from 163 patients (February-May 2014) who underwent VATS lobectomy of lung cancer with insertion of one chest drain (16 F or 28 F) were analyzed. hTe following post-operative data were evaluated: primary healing of tube incision, CXR abnormalities (pneumothorax, lfuid, atelectasis, subcutaneous emphysema, and hematoma), drainage time, new drain insertion, and wound healing at the site of insertion.Results A total of 75 patients received 28 F chest tubes, and 88 patients received 16 F chest tubes. Both groups were similar in age, gender, comorbidities, and pathological evaluation of resection specimens. Atfer adjust-ment, no statistically signiifcant difference was found between the two groups in relation to tube-related complications includ-ing residual pneumothoraces (4.00%vs 4.44%;P=0.999), subcutaneous emphysema (8.00%vs 6.67%;P=0.789), retained hemothorax (0vs41%,P=0.253), and drainage time [(28.4±16.12) hvs(22.1±11.8) h;P=0.120)] hTe average total drainage volume and rrhythmia rates of the 16 F group [(365±106) mL, 14.67%)] was less than that of the 28 F group [(665±217) mL, 4.5%;P=0.030,P=0.047]. hTe rates of primary healing at the site of insertion in the 16 F group (95.45%) was higher than that in the 28 F group (77.73%,P=0.039). A signiifcant difference was found on the post-operative length of stay of the two groups [(4.23±0.05) dvs(4.57±0.16) d,P=0.078].Conclusion hTe use of 16 F chest tube for VATS lobectomy of patients with lung cancer did not affect the clinically relevant outcomes tested. However, 16 F chest tube facilitated faster wound healing at the site of insertion.