Retrospective study on the effect of intraoperative flushing treatment with nocardia rubra cell-wall skeleton on drainage after radical surgery of lung cancer_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YE Guanzhi , XU Zhenyang , ZHU Xiaolei , LIU Hongming , LI Ning ,  JIANG Jie ,  GENG Guojun

Department of Thoracic Surgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361003, Fujian, P. R. China;

Corresponding author：

JIANG Jie, Email: jiangjie06@126.com; GENG Guojun, Email: ggj622@126.com

Keywords：

Nocardia rubra cell-wall skeleton; chest fluid drainage volume; radical surgery of lung cancer

DOI：

10.7507/1007-4848.202507051

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To evaluate the efficacy and safety of intraoperative pleural irrigation with nocardia rubra cell-wall skeleton (N-CWS) for reducing pleural effusion drainage after radical surgery for lung cancer. Methods A retrospective analysis was conducted on the clinical data of lung cancer patients who underwent lobectomy and mediastinal lymph node dissection at the First Affiliated Hospital of Xiamen University between December 2024 and May 2025. Patients were divided into a control group and an irrigation group based on the intraoperative use of N-CWS. Patients in the irrigation group received pleural irrigation with 800 μg of N-CWS diluted in 10 mL of normal saline. The following outcomes were compared between the two groups: pleural effusion drainage volume at 0-24 h, 24-48 h, and 48-72 h postoperatively; degree of air leak; chest tube duration; postoperative length of stay; and the incidence of adverse events (fever, chest pain, and vomiting). Results A total of 245 patients were included (97 males, 148 females) with a mean age of (61.28±6.26) years, with 205 in the control group and 40 in the irrigation group. Compared to the control group, the irrigation group showed significantly lower pleural effusion drainage volumes at 0-24 h, 24-48 h, and 48-72 h, as well as shorter chest tube duration and postoperative length of stay (all P<0.05). There was no significant difference in the degree of postoperative air leak (P=0.801). No significant differences were observed between the two groups regarding the highest body temperature within 72 h post-surgery (P=0.130), fever grade (P=0.450), severity of chest pain (P=0.138), or the incidence of nausea and vomiting (P=0.376). Conclusion Intraoperative pleural irrigation with N-CWS in patients undergoing lobectomy and mediastinal lymph node dissection for lung cancer can significantly reduce postoperative pleural effusion drainage volume, shorten chest tube duration, and decrease the length of hospital stay. The procedure is safe and feasible.

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3.	倪爽, 路子蕴, 孙行, 等. 快速康复病房腔镜下肺结节切除术患者术后肺部并发症危险因素分析[J]. 南京医科大学学报(自然科学版), 2025, 45(1): 48-55.Shuang Ni, Ziyun Lu, Xing Sun, et al. Analysis of risk factors for postoperative pulmonary complications in patients undergoing laparoscopic pulmonary nodule resection in the rapid recovery ward[J]. Journal of Nanjing Medical University (Natural Science Edition), 2025, 45(1): 48-55. ).
4.	Greif B, Žgajnar J, Štupnik T. Impact of chest tube type on pain, drainage efficacy, and short-term treatment outcome following video-assisted thoracoscopic surgery lobectomy: a randomized controlled trial comparing coaxial silicone drains and standard polyvinyl chloride drains. J Thorac Dis. 2025, 17(2): 932-943.
5.	张慧玲, 郑志博, 梁乃新, 等. 老年患者胸腔镜肺切除术后并发症的影响因素研究[J]. 协和医学杂志, 2025.Huiling Zhang, Zhibo Zheng, Naixin Liang, et al. Study on the influencing factors of postoperative complications in elderly patients undergoing thoracoscopic lung resection[J]. Medical Journal of Peking Union Medical College Hospital, 2025.
6.	Bhatnagar R, Piotrowska HEG, Laskawiec-Szkonter M, et al. Effect of Thoracoscopic Talc Poudrage vs Talc Slurry via Chest Tube on Pleurodesis Failure Rate Among Patients With Malignant Pleural Effusions: A Randomized Clinical Trial. JAMA. 2020, 323(1): 60-69.
7.	肖晓辉, 雷丰丰, 刘华, 等. 内科胸腔镜下碘伏胸膜固定术治疗肺癌伴恶性胸腔积液[J]. 湖北民族大学学报(医学版), 2020, 37(1): 99-101.Xiaohui Xiao, Fengfeng Lei, Hua Liu, et al. Internal medicine thoracoscopic iodine fixation for the treatment of lung cancer with malignant pleural effusion[J]. Journal of Hubei University for Nationalities (Medical Edition), 2020, 37(1): 99-101. ).
8.	Shinno Y, Kage H, Chino H, et al. Old age and underlying interstitial abnormalities are risk factors for development of ARDS after pleurodesis using limited amount of large particle size talc. Respirology. 2018, 23(1): 55-59.
9.	魏萍, 张川林, 陈志斌. 红色诺卡氏菌细胞壁骨架对70例肺癌恶性胸腔积液患者近远期预后的影响[J]. 广州医科大学学报, 2018(6): 53-56.Ping Wei, Chuanlin Zhang, Zhibin Chen. The effect of red Nocardia cell wall skeleton on the short- and long-term prognosis of 70 patients with malignant pleural effusion caused by lung cancer[J]. Journal of Guangzhou Medical University, 2018(6): 53-56. ).
10.	Zhao Y, Yu L, Wang L, Wu Y, Chen H, Wang Q, Wu Y. Current status of and progress in the treatment of malignant pleural effusion of lung cancer. Front Oncol. 2023, 12: 961440.
11.	吴灿兴, 胡树桥, 马骏, 等. 肺癌术后肺部并发症的预测因素分析[J]. 中华胸部外科电子杂志, 2019, 6(4): 229-233.Canxing Wu, Shuqiao Hu, Jun Ma, et al. Predictive factors analysis of postoperative pulmonary complications in lung cancer[J]. Chinese Journal of Thoracic Surgery, 2019, 6(4): 229-233. ).
12.	Yusa J, Tanaka K, Sata Y, et al. Predictors of intraoperative and postoperative air leakage in anatomical pulmonary resection. Surg Today. 2025. doi: 10.1007/s00595-025-03004-2. Epub ahead of print.
13.	Boira I, Galán Negrillo M, Gañán Boscá A. Acute respiratory distress syndrome secondary to talc pleurodesis. Med Clin (Barc). 2023, 161(9): 411-412.
14.	Samadi Takaldani AH, Javanshir N, Negaresh M, et al. A Case of Acute Respiratory Distress Syndrome Following Pleurodesis With Talc. Clin Med Insights Case Rep. 2023, 16: 11795476231170196.
15.	Terra RM, da Costa PB, Dela Vega AJM, et al. Adverse events after pleurodesis in patients with malignant pleural effusion. J Thorac Dis. 2020, 12(7): 3507-3513.
16.	Zhang W, Zhao YL, Li SJ, et al. Complications of thoracoscopic talc insufflation for the treatment of malignant pleural effusions: a meta-analysis. J Cardiothorac Surg. 2021, 16(1): 125-132.
17.	Feller-Kopman DJ, Reddy CB, DeCamp MM, et al. Management of Malignant Pleural Effusions. An Official ATS/STS/STR Clinical Practice Guideline. Am J Respir Crit Care Med. 2018, 198(7): 839-849.
18.	Stayner LT, Carreón-Valencia T, Demers PA, et al. Carcinogenicity of talc and acrylonitrile. Lancet Oncol. 2024, 25(8): 962-963.
19.	Mohammed SM, Al-Saedi HFS, Mohammed AQ, et al. Mechanisms of Bleomycin-induced Lung Fibrosis: A Review of Therapeutic Targets and Approaches. Cell Biochem Biophys. 2024, 82(3): 1845-1870.
20.	张邵丞, 高学军. 非小细胞肺癌患者术后持续性肺漏气的研究进展[J]. 医药前沿, 2022, 12(35): 37-40.Shaocheng Zhang, Xuejun Gao. Research progress on persistent postoperative lung gas leakage in non-small cell lung cancer patients[J]. Frontiers of Medicine, 2022, 12(35): 37-40. ).
21.	徐冰南, 金亚彬, 李枚格. 外用红色诺卡氏菌细胞壁骨架制剂(Nr-CWS)治疗宫颈上皮内瘤变患者人乳头瘤病毒宫颈持续感染的临床疗效分析[J]. 妇产与遗传(电子版), 2022, 12(01): 38-41.Bingnan Xu, Yabin Jin, Meige Li. Clinical efficacy analysis of external application of red Nocardia cell wall scaffold preparation (Nr-CWS) in the treatment of persistent human papillomavirus cervical infection in patients with cervical intraepithelial neoplasia[J]. Obstetrics and Gynecology and Genetics (Electronic Version), 2022, 12(01): 38-41. ).
22.	Li Q, Guo L, Wang J, et al. Exosomes derived from Nr-CWS pretreated MSCs facilitate diabetic wound healing by promoting angiogenesis via the circIARS1/miR-4782-5p/VEGFA axis. Chin J Nat Med. 2023, 21(3): 172-184.
23.	闻丹丹, 李强, 沈才齐, 等. 外用红色诺卡氏菌细胞壁骨架提高脂肪间充质干细胞活性修复糖尿病创面[J]. 中国组织工程研究, 2022, 26(07): 1038-1044.Dandan Wen, Qiang Li, Caiqi Shen, et al. External application of Nocardia rubrum cell wall skeleton improves the activity of adipose derived mesenchymal stem cells to repair diabetes wounds[J]. China Tissue Engineering Research, 2022, 26(07): 1038-1044. ).
24.	Hu K, Xu Y, Li X, et al. The Nocardia Rubra Cell Wall Skeleton Regulates Macrophages and Promotes Wound Healing. Curr Issues Mol Biol. 2022, 44(12): 5995-6005.
25.	Wang Y, Hu Y, Ma B, et al. Nocardia rubra cell wall skeleton accelerates cutaneous wound healing by enhancing macrophage activation and angiogenesis. J Int Med Res. 2018, 46(6): 2398-2409.
26.	齐利, 陈岩. 红色诺卡氏菌细胞壁骨架胸腔内注射治疗恶性胸腔积液的临床效果[J]. 中国实用医刊, 2019, 46(20): 104-106.Li Qi, Yan Chen. Clinical effect of intrathoracic injection of red Nocardia cell wall skeleton in the treatment of malignant pleural effusion[J]. Chinese Journal of Practical Medicine, 2019, 46(20): 104-106. ).
27.	杨珊, 张文进, 曹淼, 等. 红色诺卡菌细胞壁骨架术中冲洗创面影响乳腺癌术后引流量的前瞻性研究[J]. 中国实用外科杂志, 2022, 42(08): 932-935.Shan Yang, Wenjin Zhang, Miao Cao, et al. A prospective study on the effect of intraoperative washing of wound surface of Nocardia rubrum cell wall skeleton on postoperative drainage of breast cancer[J]. Chinese Journal of Practical Surgery, 2022, 42(08): 932-935. ).
28.	王晓楠, 郭瑞霞, 邱海峰, 等. 外用红色诺卡氏菌细胞壁骨架治疗高危型HPV持续感染伴或不伴低级别鳞状上皮内病变临床疗效的前瞻性研究[J]. 中国妇产科临床杂志, 2024, 25(2): 155-159.Xiaonan Wang, Ruixia Guo, Haifeng Qiu, et al. Prospective study on the clinical efficacy of topical application of red Nocardia cell wall cytoskeleton in the treatment of persistent high-risk HPV infection with or without low-grade squamous intraepithelial lesions[J]. Chinese Journal of Obstetrics and Gynecology, 2024, 25(2): 155-159. ).
29.	Shen C, Wei W, Zhang A, et al. External application of a Nocardia rubra cell wall skeleton in the treatment of diabetic foot ulcers. Chinese Journal of Plastic and Reconstructive Surgery, 2022, 4(1): 17-19.

1. Filho AM, Laversanne M, Ferlay J, et al. The GLOBOCAN 2022 cancer estimates: Data sources, methods, and a snapshot of the cancer burden worldwide. Int J Cancer. 2025, 156(7): 1336-1346.
2. 刘东东, 沈剑, 黄思远, 等. 肺癌根治术后肺部感染的相关因素分析[J]. 中华全科医学, 2021, 19(4): 550-553.Dongdong Liu, Jian Shen, Siyuan Huang, et al. Analysis of Related Factors of Postoperative Pulmonary Infection in Lung Cancer Patients[J]. Chinese Journal of General Practice, 2021, 19(4): 550-553. ).
3. 倪爽, 路子蕴, 孙行, 等. 快速康复病房腔镜下肺结节切除术患者术后肺部并发症危险因素分析[J]. 南京医科大学学报(自然科学版), 2025, 45(1): 48-55.Shuang Ni, Ziyun Lu, Xing Sun, et al. Analysis of risk factors for postoperative pulmonary complications in patients undergoing laparoscopic pulmonary nodule resection in the rapid recovery ward[J]. Journal of Nanjing Medical University (Natural Science Edition), 2025, 45(1): 48-55. ).
4. Greif B, Žgajnar J, Štupnik T. Impact of chest tube type on pain, drainage efficacy, and short-term treatment outcome following video-assisted thoracoscopic surgery lobectomy: a randomized controlled trial comparing coaxial silicone drains and standard polyvinyl chloride drains. J Thorac Dis. 2025, 17(2): 932-943.
5. 张慧玲, 郑志博, 梁乃新, 等. 老年患者胸腔镜肺切除术后并发症的影响因素研究[J]. 协和医学杂志, 2025.Huiling Zhang, Zhibo Zheng, Naixin Liang, et al. Study on the influencing factors of postoperative complications in elderly patients undergoing thoracoscopic lung resection[J]. Medical Journal of Peking Union Medical College Hospital, 2025.
6. Bhatnagar R, Piotrowska HEG, Laskawiec-Szkonter M, et al. Effect of Thoracoscopic Talc Poudrage vs Talc Slurry via Chest Tube on Pleurodesis Failure Rate Among Patients With Malignant Pleural Effusions: A Randomized Clinical Trial. JAMA. 2020, 323(1): 60-69.
7. 肖晓辉, 雷丰丰, 刘华, 等. 内科胸腔镜下碘伏胸膜固定术治疗肺癌伴恶性胸腔积液[J]. 湖北民族大学学报(医学版), 2020, 37(1): 99-101.Xiaohui Xiao, Fengfeng Lei, Hua Liu, et al. Internal medicine thoracoscopic iodine fixation for the treatment of lung cancer with malignant pleural effusion[J]. Journal of Hubei University for Nationalities (Medical Edition), 2020, 37(1): 99-101. ).
8. Shinno Y, Kage H, Chino H, et al. Old age and underlying interstitial abnormalities are risk factors for development of ARDS after pleurodesis using limited amount of large particle size talc. Respirology. 2018, 23(1): 55-59.
9. 魏萍, 张川林, 陈志斌. 红色诺卡氏菌细胞壁骨架对70例肺癌恶性胸腔积液患者近远期预后的影响[J]. 广州医科大学学报, 2018(6): 53-56.Ping Wei, Chuanlin Zhang, Zhibin Chen. The effect of red Nocardia cell wall skeleton on the short- and long-term prognosis of 70 patients with malignant pleural effusion caused by lung cancer[J]. Journal of Guangzhou Medical University, 2018(6): 53-56. ).
10. Zhao Y, Yu L, Wang L, Wu Y, Chen H, Wang Q, Wu Y. Current status of and progress in the treatment of malignant pleural effusion of lung cancer. Front Oncol. 2023, 12: 961440.
11. 吴灿兴, 胡树桥, 马骏, 等. 肺癌术后肺部并发症的预测因素分析[J]. 中华胸部外科电子杂志, 2019, 6(4): 229-233.Canxing Wu, Shuqiao Hu, Jun Ma, et al. Predictive factors analysis of postoperative pulmonary complications in lung cancer[J]. Chinese Journal of Thoracic Surgery, 2019, 6(4): 229-233. ).
12. Yusa J, Tanaka K, Sata Y, et al. Predictors of intraoperative and postoperative air leakage in anatomical pulmonary resection. Surg Today. 2025. doi: 10.1007/s00595-025-03004-2. Epub ahead of print.
13. Boira I, Galán Negrillo M, Gañán Boscá A. Acute respiratory distress syndrome secondary to talc pleurodesis. Med Clin (Barc). 2023, 161(9): 411-412.
14. Samadi Takaldani AH, Javanshir N, Negaresh M, et al. A Case of Acute Respiratory Distress Syndrome Following Pleurodesis With Talc. Clin Med Insights Case Rep. 2023, 16: 11795476231170196.
15. Terra RM, da Costa PB, Dela Vega AJM, et al. Adverse events after pleurodesis in patients with malignant pleural effusion. J Thorac Dis. 2020, 12(7): 3507-3513.
16. Zhang W, Zhao YL, Li SJ, et al. Complications of thoracoscopic talc insufflation for the treatment of malignant pleural effusions: a meta-analysis. J Cardiothorac Surg. 2021, 16(1): 125-132.
17. Feller-Kopman DJ, Reddy CB, DeCamp MM, et al. Management of Malignant Pleural Effusions. An Official ATS/STS/STR Clinical Practice Guideline. Am J Respir Crit Care Med. 2018, 198(7): 839-849.
18. Stayner LT, Carreón-Valencia T, Demers PA, et al. Carcinogenicity of talc and acrylonitrile. Lancet Oncol. 2024, 25(8): 962-963.
19. Mohammed SM, Al-Saedi HFS, Mohammed AQ, et al. Mechanisms of Bleomycin-induced Lung Fibrosis: A Review of Therapeutic Targets and Approaches. Cell Biochem Biophys. 2024, 82(3): 1845-1870.
20. 张邵丞, 高学军. 非小细胞肺癌患者术后持续性肺漏气的研究进展[J]. 医药前沿, 2022, 12(35): 37-40.Shaocheng Zhang, Xuejun Gao. Research progress on persistent postoperative lung gas leakage in non-small cell lung cancer patients[J]. Frontiers of Medicine, 2022, 12(35): 37-40. ).
21. 徐冰南, 金亚彬, 李枚格. 外用红色诺卡氏菌细胞壁骨架制剂(Nr-CWS)治疗宫颈上皮内瘤变患者人乳头瘤病毒宫颈持续感染的临床疗效分析[J]. 妇产与遗传(电子版), 2022, 12(01): 38-41.Bingnan Xu, Yabin Jin, Meige Li. Clinical efficacy analysis of external application of red Nocardia cell wall scaffold preparation (Nr-CWS) in the treatment of persistent human papillomavirus cervical infection in patients with cervical intraepithelial neoplasia[J]. Obstetrics and Gynecology and Genetics (Electronic Version), 2022, 12(01): 38-41. ).
22. Li Q, Guo L, Wang J, et al. Exosomes derived from Nr-CWS pretreated MSCs facilitate diabetic wound healing by promoting angiogenesis via the circIARS1/miR-4782-5p/VEGFA axis. Chin J Nat Med. 2023, 21(3): 172-184.
23. 闻丹丹, 李强, 沈才齐, 等. 外用红色诺卡氏菌细胞壁骨架提高脂肪间充质干细胞活性修复糖尿病创面[J]. 中国组织工程研究, 2022, 26(07): 1038-1044.Dandan Wen, Qiang Li, Caiqi Shen, et al. External application of Nocardia rubrum cell wall skeleton improves the activity of adipose derived mesenchymal stem cells to repair diabetes wounds[J]. China Tissue Engineering Research, 2022, 26(07): 1038-1044. ).
24. Hu K, Xu Y, Li X, et al. The Nocardia Rubra Cell Wall Skeleton Regulates Macrophages and Promotes Wound Healing. Curr Issues Mol Biol. 2022, 44(12): 5995-6005.
25. Wang Y, Hu Y, Ma B, et al. Nocardia rubra cell wall skeleton accelerates cutaneous wound healing by enhancing macrophage activation and angiogenesis. J Int Med Res. 2018, 46(6): 2398-2409.
26. 齐利, 陈岩. 红色诺卡氏菌细胞壁骨架胸腔内注射治疗恶性胸腔积液的临床效果[J]. 中国实用医刊, 2019, 46(20): 104-106.Li Qi, Yan Chen. Clinical effect of intrathoracic injection of red Nocardia cell wall skeleton in the treatment of malignant pleural effusion[J]. Chinese Journal of Practical Medicine, 2019, 46(20): 104-106. ).
27. 杨珊, 张文进, 曹淼, 等. 红色诺卡菌细胞壁骨架术中冲洗创面影响乳腺癌术后引流量的前瞻性研究[J]. 中国实用外科杂志, 2022, 42(08): 932-935.Shan Yang, Wenjin Zhang, Miao Cao, et al. A prospective study on the effect of intraoperative washing of wound surface of Nocardia rubrum cell wall skeleton on postoperative drainage of breast cancer[J]. Chinese Journal of Practical Surgery, 2022, 42(08): 932-935. ).
28. 王晓楠, 郭瑞霞, 邱海峰, 等. 外用红色诺卡氏菌细胞壁骨架治疗高危型HPV持续感染伴或不伴低级别鳞状上皮内病变临床疗效的前瞻性研究[J]. 中国妇产科临床杂志, 2024, 25(2): 155-159.Xiaonan Wang, Ruixia Guo, Haifeng Qiu, et al. Prospective study on the clinical efficacy of topical application of red Nocardia cell wall cytoskeleton in the treatment of persistent high-risk HPV infection with or without low-grade squamous intraepithelial lesions[J]. Chinese Journal of Obstetrics and Gynecology, 2024, 25(2): 155-159. ).
29. Shen C, Wei W, Zhang A, et al. External application of a Nocardia rubra cell wall skeleton in the treatment of diabetic foot ulcers. Chinese Journal of Plastic and Reconstructive Surgery, 2022, 4(1): 17-19.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesRetrospective study on the effect of intraoperative flushing treatment with nocardia rubra cell-wall skeleton on drainage after radical surgery of lung cancer

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