Proper management of chest drainage after pulmonary lobectomy is a topic that every thoracic surgeon must face up to. Reasonable chest drainage plays a critical role in postoperative normal physiological recovery. However， there are still controversies and discrepancies in many aspects of chest drainage management after pulmonary lobectomy. In this review，we focus on five aspects of chest drainage management after pulmonary lobectomy，including the choice of chest drainage system，single or double chest tubes，suction or not，treatment of persistent air leak，and removal of chest tube.
ObjectiveTo observe the impacts of initial therapy on clinical outcome of patients with community-acquired thoracic infection by retrospective analysis. MethodsClinical data of acute community-acquired thoracic infection patients who met the British Thoracic Society diagnostic criteria were collected. The patients were divided into two groups according to whether adequate initial antibiotic therapy and pleural effusion drainage were performed, namely an adequate group (31 patients) and an inadequate group (17 patients). Clinical manifestations, inflammatory markers, hospital stay and hospital costs were analyzed between the two groups. ResultsFor age, gender, infection sites, and coincident diseases, there were no significant differences between the two groups. Compared with the inadequate group, temperature of the adequate group was significantly decreased, especially on hospital day 5, 6, 7[(37.4±0.1)℃ vs. (38.3±0.2)℃, P < 0.001; (37.4±0.1)℃ vs. (37.9±0.1)℃, P < 0.05; (37.4±0.1)℃ vs. (38.1±0.2)℃, P < 0.01]. The level of serum C-reactive protein (CRP) in first week was also significantly reduced in the adequate group[(123.1±13.8) mg/L vs. (182.7±25.3) mg/L, P < 0.05]. However, there were no differences in white cell counts, percentage of neutrophils, or erythrocyte sedimentation rate between the two groups in six-week follow-up. The adequate group had shorter hospital stay[(25±4) days vs. (34±4) days, P < 0.05] and lower hospital costs[(28 367±3 328) yuan vs. (43 334±7 134) yuan, P < 0.05] compared with the inadequate group. ConclusionsThe initial therapy with appropriate antibiotics and effective thoracic drainage can significantly decrease the temperature and CRP of patients with thoracic infection, as well as the cost of hospitalization and the length of stay. Our study reveals that the temperature which is lower than 37.5℃ on the 5th day of therapy and the CRP in the first follow-up week are sensitive predictors of initial treatment effect, which may be helpful to guide the following therapeutic strategies.
ObjectiveTo analyze the influencing factors for postoperative thoracic drainage duration in patients with cavitary pulmonary tuberculosis and clinical nursing strategies. MethodsA retrospective analysis was conducted on the clinical data of patients with cavitary pulmonary tuberculosis who underwent surgical treatment in the Department of Thoracic Surgery at Public Health Clinical Center of Chengdu from December 2022 to December 2024. Patients with a drainage time ≤7 days were included in the recovery group, while those with a drainage time >7 days were included in the control group. Data on patients' preoperative Hamilton anxiety and depression scores, perioperative nursing conditions were collected, and factors affecting chest drainage time were analyzed. ResultsA total of 186 patients were included in this study, including 119 males and 67 females, with an average age of (36.10±15.20) years. The average chest drainage tube retention time was (10.59±9.24) days. Preoperative Hamilton anxiety and depression assessments showed that 47.31% (88/186) of patients were anxious, and 31.72% (59/186) were depressed. Multivariate analysis indicated that having a smoking history, undergoing open-chest surgery, prolonged postoperative use of analgesic pumps, preoperative anxiety, and depression were independent risk factors for chest drainage time >7 days (P<0.05); frequent coughing and longer average daily activity time postoperatively were protective factors for chest drainage time >7 days (P<0.05). ConclusionPatients undergoing surgery for pulmonary tuberculosis often experience anxiety and depression preoperatively. In the clinical nursing of patients with cavitary pulmonary tuberculosis, efforts should be made preoperatively to help patients adjust their anxious and depressed emotions, control smoking, and prefer minimally invasive surgery; postoperatively, reducing analgesic duration, increasing cough frequency, promoting effective coughing, and extending average daily activity time can effectively shorten the postoperative chest drainage time, facilitating the rapid recovery of patients after surgery for pulmonary tuberculosis.
ObjectiveTo investigate the correlation between the postoperative day 1 (POD1) drainage volume and postoperative pulmonary complications (PPCs). MethodsThe clinical data of 254 non-small cell lung cancer (NSCLC) patients undergoing thoracoscopic lobectomy at our department from January 2014 to June 2018 were retrospectively reviewed. According to whether there were PPCs after operation, patients were divided into a PPCs group (51 patients, 33 males and 18 females, aged 65.2±7.3 years) and a non-PPCs group (203 patients, 110 males and 93 females, aged 62.4±8.2 years). The correlation between POD1 drainage volume and PPCs was analyzed. ResultsThe POD1 drainage volume in the PPCs group was significantly more than that in the non-PPCs group (337.5±127.4 ml vs. 208.7±122.9 ml, P=0.000). The result of regression analysis showed that POD1 drainage volume was an independent risk factor for the occurrence of PPCs. Receiver operating characteristic curve (ROC curve) analysis showed that POD1 drainage volume of 265 ml was the cut-off point to predict PPCs. The rate of PPCs in the group of POD1 drainage volume less than 265 ml was significantly lower than that in the group of drainage volume more than 265 ml (8.3% vs. 43.0%, P=0.000). ConclusionThe POD1 drainage volume is closely related to the occurrence of PPCs, which can be used to predict the occurrence of PPCs.
ObjectiveWe aimed to further investigate the feasibility of using small bore chest tubes or even without chest tube insertion after da Vinci robot-assisted thoracic surgery. MethodsWe retrospectively analyzed initial 70 patients between September 12, 2014 and March 30, 2015 as a control group at the department of thoracic surgery, the First Affiliated Hospital of Zhejiang University, and proposed four schemes. There are 31 males and 39 females with mean age of 57.1±9.8 (ranged from 30-80 years). We applied those four schemes for the last 30 patients as an experimental group. There are 12 males and 18 females with mean age of 58.8±8.1 (ranged 42-73 years). ResultsThe days in hospital after surgery ranged 2-25 days and there was no severe complication. After the surgery, the pain scores of the trial group are lower than that of the control group. And the schemes 1 and schemes 2 of trial group reduced significantly than the control group (P<0.05). There is no significant difference of the rate of the complication caused by poor drainage between the trial group and the control group (P>0.05). But the pain score after surgery is lower than that of the control group (P<0.05). ConclusionOptimizing thoracic drainage strategy after da Vinci robot-assisted thoracic surgery is safe, possible and helpful to relieve postoperative pain.
ObjectiveTo evaluate the effectiveness and safety of a central venous catheter for thoracic drainage after video-assisted thoracoscopic lobectomy compared with a conventional chest tube.MethodsThis study collected 200 patients with lung cancer who underwent thoracoscopic lobectomy and systematic hilar and mediastinal lymph node dissection between January 2018 and September 2019 in our hospital. The patients were randomly divided into two groups, including a group A (left with 28F chest tubes postoperatively) and a group B (left with 12G central venous catheters postoperatively). Patients in both groups were left with 2 chest tubes after upper lobectomy and 1 chest tube after middle or lower lobectomy. Duration and total volume of drainage, length of hospital stay, maximum visual analogue scale score and so forth were compared between the two groups.ResultsFinally, 151 patients were included for analysis. There were 73 patients in the group A, including 26 males and 47 females, with an average age of 55.38±9.95 years, and 78 patients in the group B, including 37 males and 41 females, with an average age of 59.86±10.18 years. No statistical difference was found between the two groups in drainage volume on postoperative day 2, and proportion of prolonged air leaks, hemothorax, chylothorax or drain reinsertion (all P>0.05). There was a statistical difference in drainage volume on postoperative day 1 [200.0 (120.0, 280.0) mL vs. 57.5 (10.0, 157.5) mL, P=0.000], postoperative day 3 [155.0 (100.0, 210.0) mL vs. 150.0 (80.0, 215.0) mL, P=0.023], total volume of drainage [890.0 (597.5, 1 530.0) mL vs. 512.5 (302.5, 786.3) mL,P=0.000], maximum pain score (2.29±0.72 points vs. 2.09±0.51 points, P=0.013) and length of hospital stay [7 (7, 9) d vs. 5 (4, 7) d, P=0.000].ConclusionCompared with conventional chest tubes, central venous catheters for chest drainage in patients with lung cancer after thoracoscopic lobectomy shortens the length of hospital stay and reduces postoperative pain.
ObjectiveTo explore the factors that affect the drainage time of da Vinci robot lung cancer surgery, to analyze the coping strategies, and to provide a basis for shortening the drainage time of patients after surgery and speeding up the patients' recovery.MethodsThe clinical data of 131 patients who underwent da Vinci robot lung cancer surgery at the Department of Thoracic Surgery, General Hospital of Northern Theater Command from January 2019 to October 2019 were retrospectively analyzed. Among them, 68 were males and 63 were females, with an average age of 59.84±9.66 years. According to the postoperative thoracic drainage time, the patients were divided into two groups including a group A (drainage time≤ 5 days) and a group B (drainage time >5 days). Univariate analysis and logistic multivariate regression analysis were used to analyze the factors that may affect postoperative drainage time, and the correlation between different influencing factors and thoracic drainage time after da Vinci robot lung cancer surgery.ResultsLogistic multivariate analysis showed that age≥60 years (P=0.014), diabetes mellitus (P=0.035), operation time≥130 min (P=0.018), number of lymph node dissections≥15 (P=0.002), and preoperative albumin<38.45 g/L (P=0.010) were independent factors affecting the drainage time of da Vinci robot lung cancer surgery.ConclusionFor elderly patients with diabetes mellitus during the perioperative period, blood glucose should be actively controlled, reasonable surgical strategies should be formulated to ensure the safety and effectiveness of the operation, while reducing intraoperative damage and shortening the operation time. After the operation, patients should be guided to strengthen active coughing, expectoration and lung expansion. Thereby it can shorten drainage time and speed up the recovery of patients after operation.
目的 介绍胸部良性疾病经单孔胸腔镜切除术后免胸腔引流管的临床经验。 方法 回顾性分析 2015 年 10 月至 2016 年 10 月我院胸外科 17 例行单孔胸腔镜手术患者的临床资料，其中男 9 例、女 8 例，年龄 33.8（17～58）岁。行肺大疱切除术 7 例，肺楔形切除术 9 例，交感神经烙断术 1 例。 结果 所有患者均经单孔胸腔镜手术有效切除，期间无中转开胸或再次开操作孔，术后不放置胸腔引流管，手术时间为（60.3±8.2）min，术中出血量为（15.2±5.1）ml，术后第 1 d、2 d、3 d 疼痛视觉模拟评分（VAS） 为 6.5±2.2，5.8±2.1，3.5±1.3，术后舒适度评分分别为 8.6±1.3，术后早期下床活动时间为（1.0±0.3）d，切口甲级愈合率 100.0%。17 例患者均无心律失常、肺部感染等并发症，术后随访 6 个月气胸均无复发。 结论 合理选择及严格基线评估，胸部良性疾病经单孔胸腔镜切除术后免胸腔引流管是安全可行的，可能有利于患者术后快速康复。