胸腔镜肺癌肺叶切除术后16 F较28 F胸腔引流管应用的临床优势

BACKGROUND AND OBJECTIVE: Post-operation management of minimally invasive thoracic surgery is similar to that of open surgery, especially on the drainage tube of the chest. The aim of this study is to compare the advantages of using 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. The following post-operative data were evaluated: primary healing of tube incision, CXR abnormalities (pneumothorax, fluid, 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. After adjustment, no statistically significant difference was found between the two groups in relation to tube-related complications including residual pneumothoraces (4.00% vs 4.44%; P > 0.999), subcutaneous emphysema (8.00% vs 6.67%; P=0.789), retained hemothorax (0 vs 41%, P=0.253), and drainage time [(28.4±16.12) h vs (22.1±11.8) h; P=0.120)] The 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]. The 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 significant difference was found on the post-operative length of stay of the two groups [(4.23±0.05) d vs (4.57±0.16) d, P=0.078]. CONCLUSION: The 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.