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Avoiding Chest Drain Placement after Thoracoscopic Wedge Resection for Pulmonary Metastasis

在肺部轉移病灶患者接受胸腔鏡肺部切除後避免放置胸部引流管

摘要


前言:傳統上,患者進行胸腔鏡肺部楔狀切除後放置胸腔引流管主要是要偵測術後的流血、漏氣或是淋巴管滲漏。然而,放置引流管往往會造成患者術後的疼痛、活動限制、或是提高傷口感染與癒合不良的機率。另外,近年來越來越多報告顯示手術切除肺部轉移性病灶對病人的癒後是有幫助的。因此,本篇報告的目的就是想探討在肺部轉移病灶患者接受胸腔鏡肺部切除後避免放置胸部引流管的影響。方法:從2013年1月到2015年7月,我們搜集了39位因肺部轉移病灶而接受胸腔鏡肺部切除的患者。若是患者符合所有設定條件,那麼該患者手術後可以考慮不放置胸腔引流管。其中A組包括19位患者因不符合條件而有放置引流管,B組則包括20位符合條件的病人而沒有放置引流管。我們針對二組的資料進行分析,包括患者本身的特性、手術檢體資料以及術後狀態。 結果:二組患者的本身特性資料並無顯著差別,然而,A組患者具有較大的肺部切除體積(51.25± 59.27 vs. 15.77±11.14 cm^3, p=0.0187),另外,B組患者則是擁有較短的術後住院天數(3.95±0.71 vs. 3.3± 1.03 days, p=0.0287)。結論:在經過篩選後的肺部轉移病灶患者,接受胸腔鏡肺部切除後避免放置胸部引流管是安全且具有好處的。

關鍵字

胸管 胸腔鏡 楔狀切除 肺轉移

並列摘要


Introduction: A chest drain traditionally was left in the pleural cavity after thoracoscopic wedge resection, to deal with possible hemorrhage, or air or lymphatic leakage. However, the placement of a chest drain might lead to some adverse effects such as pain and immobilization, and increase the risk of wound infection and poor healing. Resection of a single pulmonary metastatic lesion might be beneficial with certain malignancies, according to recent research. The aim of this retrospective study was to estimate the outcomes of patients who underwent thoracoscopic wedge resection without chest drain placement for pulmonary metastasis. Methods: From January 2013 to July 2015, 39 patients who received thoracoscopic wedge resection for pulmonary metastasis were enrolled in this study. The patients who met all the following criteria were considered as those who do not need to receive chest drain placement during surgery: (1) no bullous or emphysematous changes in the lung, (2) no air leaks grossly or during the water seal test, (3) no dense adhesion of pleura, and (4) no easily oozing or accumulating pleural effusion. Otherwise, a chest drain was placed intraoperatively. A total of 19 patients who did not meet the criteria were assigned to the chest drain placement group (Group A), and 20 patients who met the criteria were assigned to the no chest drain placement group (Group B). The following data of the 2 groups were analyzed: patient characteristics, specimen data and postoperative conditions. Results: There was no significant difference between the 2 groups in patient characteristics. Group A patients had a greater resected lung volume (51.25±59.27 vs. 15.77±11.14 cm^3, p=0.0187), and Group B patients had shorter postoperative hospital stay (3.95±0.71 vs. 3.3±1.03 days, p=0.0287). Conclusions: Not placing a chest drain after thoracoscopic wedge resection for pulmonary metastasis might be safe and beneficial for selected patients.

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