ObjectiveTo investigate the clinical effect of metal supported multi-sided versus ordinary ultra-fine drainage tube in the uniportal video-assisted thoracic surgery (VATS) lower pulmonary lobectomy. MethodsFrom January 2021 to June 2022, the clinical data of patients who underwent uniportal VATS lower lobectomy in our hospital were retrospectively analyzed. According to the different types of ultra-fine drainage tubes used in the surgery, the patients were divided into an experimental group (using multi-sided hole 10F ultra-fine drainage tubes with metal support) and a control group (using ordinary 12F ultra-fine drainage tubes). The clinical data of the two groups were compared. ResultsA total of 190 patients were enrolled, including 108 males and 82 females. There were 90 patients in the experimental group aged 56.60±10.14 years; and 100 patients in the control group aged 57.07±11.04 years. The incidences of postoperative lung infection and pleural effusion in the experimental group were lower than those in the control group, with statistically significant differences (P<0.05). The postoperative visual analogue scale score, the need to adjust the chest drainage tube after the surgery, the need for chest puncture after the surgery, the time of postoperative chest tube removal, and the hospitalization cost were statistically different (P<0.05). There was no statistical difference in the length of postoperative hospital stay or the incidences of postoperative lung leakage, arrhythmia, and atelectasis complications (P>0.05). ConclusionCompared with the ordinary ultra-fine drainage tubes, multi-sided hole ultra-fine drainage tubes with metal support can reduce the incidences of lung infection and pleural effusion complications after the uniportal VATS lower lobectomy, reduce the pain and economic burden, which can be applied in the uniportal VATS lower lobectomy.
ObjectiveTo assess the safety for removing nasogastric tube(NGT)within postoperative 24 h in Whipple pancreaticoduodenectomy (PD)patients. MethodsThe clinical data of 310 patients performed classic Whipple PD from January 2008 to March 2013 in this hospital were analyzed retrospectively. The patients were divided into early (≤24 h after operation)removing NGT group and late( > 24 h after operation)removing NGT group according to the time of NGT duration. The ratio of NGT reinsertion, time of solid diet tolerance, hospital stay, mortality, and major complications associated with PD were compared between two groups. Results①The demography and preoperative comorbidities characteristics were similar(P > 0.05).②There was no statistical difference of ratio of NGT reinsertion between two groups(P=0.450).③The differences of rates of major complications associated with PD and mortality were not statistically different(P > 0.05)by univariate analysis, but the rate of total complications in the early removing NGT group was significantly lower than that in the late removing NGT group (P=0.014)by multivariate analysis.④The average time of solid diet tolerance(P=0.013)and average hospital stay(P < 0.001)in the early removing NGT group were significantly shorter than those in the late removing NGT group. ConclusionFor patients comfort, NGT following PD should be removed as early as possible even immediately after extubation for selective patients.
ObjectiveThe pleural injury caused by harvesting internal mammary artery (LIMA) can significantly increase the possibility of early pleural effusion after off-pump coronary artery bypass grafting (OPCABG). We compared the differences in pleural effusion, pain severity, and early lung function in different treatments to find the optimal strategy.MethodsA total of 300 patients receiving OPCABG using LIMA with left pleural lesion were selected (176 males and 124 females, mean age of 63.1±8.7 years). After bypass surgery, patients with pleural rupture were randomly divided into three groups: group A (n=100) received a pericardial drainage tube and a left chest tube inserted from the midline (subxyphoid); group B (n=100) had a pericardial drainage tube and a tube placed in the sixth intercostal space at the midaxillary line; group C (n=100) with the broken pleura sutured, had a pericardial drainage tube and a mediastinal drainage tube inserted. All patients underwent pulmonary function testing and arterial blood gas analysis on postoperative days (PODs) 5. The three methods were analyzed and evaluated.ResultsTotal drainage: group B (852±285 ml)>group C (811±272 ml)>group A (703±226 ml); there was no significant difference between the group B and group C, but they were statistically different from the group A (P<0 05="" patients="" with="" pleural="" effusion="" after="" removal="" of="" drainage="" tubes:="" group="" a="" 13="" patients="">group B (7 patients)>group C (3 patients), and there was significant difference among the three groups (P<0 05="" pain="" sensation="" the="" day="" after="" extubation:="" group="" b="" 2="" 4="" 0="" 8="" 3="" 8="" 0="" 9="">group A (1.9±0.7, 3.3±0.8)>group C (1.1±0.6, 2.5±0.8), there was significant difference among the three groups (P<0 05="" pain="" sensationon="" on="" postoperative="" days="" 5:="" group="" b="" 0="" 3="" 0="" 2="" 0="" 6="" 0="" 5="">group A (0.3±0.3, 0.5±0.4)>group C (0.2±0.2, 0.5±0.3), and there was no significant difference among the three groups. Vital capacity on postoperative days 5: there was no significant difference between the group B and group C, and both groups were greater than group A (P<0.05). There was no difference in FEV1 and PCO2 among the three groups. Group C was better than group A in PO2 on postoperative day 5 (P<0.05).ConclusionSuturing the broken pleura during the operation can not only reduce the degree of postoperative pain but also have less pleural effusion and better pulmonary function. It can be used as the preferred method.
ObjectiveTo compare and evaluate the application of two types of chest drainage in patients who had undergone the lung lobe resection. MethodWe retrospective analyzed the clinical data of 240 patients who underwent left lobe resection. The patients were divided into a single conventional drainage group with single chest drainage tube (normal group) and a single conventional drainage tube combined with drainage of disposable surgical negative pressure drainage ball (NPBD) (combination group). There were 140 patients including 86 males and 54 females at mean age of 48.76± 4.92 years in the normal group. There were 100 patients including 58 males and 42 females at mean age of 48.37± 4.56 years in the combination group. We compared the outcomes between the two groups. ResultThe postoperative pathological results revealed there were 12 patients with tuberculosis (TB), 87 patients with squamous carcinoma, and 41 patients with adenocarcinoma in the normal group; 5 patients with TB, 66 patients with squamous carcinoma, and 29 patients with adenocarcinoma in the combination group. There were statistical differences in postoperative hospital stay (11.35± 2.78 d vs. 9.33± 2.46 d), chest drainage tube indwelling time (6.75± 2.10 d vs. 8.28± 2.10 d), total volume of chest drainage (1 176.07± 384.62 ml vs. 926.50± 22.35 ml) with P values less than 0.001 between the normal group and the combination group. No statistical difference was found between the two groups in complications (P>0.05). ConclusionSingle conventional drainage tube combined with drainage of disposable surgical negative pressure drainage ball (NPBD) has more advantages than single conventional chest drainage tube drainage, and is worth to be applied popularly in clinic.
ObjectiveTo compare postoperative efficacy of thoracoscopic partial pneumonectomy with or without thoracic drainage tube postoperatively.MethodsThe PubMed, Wanfang database, CNKI and Web of Science from January 2000 to August 2020 were searched by computer to collect randomized controlled studies (RCT), cohort studies and case-control studies on the efficacy of chest drainage tube placement versus no placement after thoracoscopic partial pneumonectomy. Two reviewers independently screened articles and extracted data to evaluate the risk of literature bias. Meta-analysis was performed with RevMan software.ResultsA total of 15 articles were included, including 1 RCT and 14 cohort studies. A total of 1 524 patients were enrolled, including 819 patients in the test group (no postoperative chest drainage tube group) and 705 patients in the control group (postoperative chest drainage tube group). Compared with the control group, the length of hospital stay in the test group was shorter (MD=–1.3, 95%CI –1.23 to –0.17, P<0.000 01) and the incidence of postoperative pneumothorax was higher (RD=0.06, 95%CI 0.01 to 0.10, P=0.01). There was no significant difference between the two groups in operation time (MD=–2.37, 95%CI –7.04 to 2.30, P=0.32), the incidence of postoperative complications (RR=2.43, 95%CI 0.79 to 1.80, P=0.39), the reintervention rate of postoperative complications (RD=0.02, 95%CI=–0.00 to 0.04, P=0.05), postoperative subcutaneous emphysema (RD=0.02, 95%CI –0.01 to 0.06, P=0.20) and the incidence of postoperative pleural effusion (RD=0.04, 95%CI –0.00 to 0.09, P=0.10) .ConclusionCompared with the patients with chest drainage tube placement after thoracoscopic partial pneumonectomy (the control group), the test group can shorten the hospital stay. Although the incidence of postoperative pneumothorax is higher than that of the control group, the operation time, incidence of postoperative subcutaneous emphysema and in-hospital complications, and reintervention rate of in-hospital complications are not statistically significant between the two groups. Therefore no chest drainage tube may be placed after partial pneumonectomy.
ObjectiveTo compare the clinical effect of single mediastinal drainage tube and both mediastinal drainage tube and closed thoracic drainage tube for the patients who received thoracoscopic radical resection of esophageal carcinoma.MethodsWe enrolled 96 esophageal carcinoma patients who received thoracoscopic radical resection from June 2016 to October 2018. Of them, 49 patients were indwelt with both mediastinal drainage tube and closed thoracic drainage tube (a chest & mediastinal drainage group, a CMD group) while the other 47 patients were indwelt with single mediastinal drainage tube (a single mediastinal drainage group, a SMD group). The total drainage volume, intubation time and incidence of postoperative complications (postoperative atelectasis, pulmonary infection, pleural effusion and anastomotic leakage) between the two groups were compared. The pain score and comfort score were also compared between the two groups.ResultsThe total drainage volume and intubation time in the SMD group were not significantly different from those in the CMD group (1 321±421 mL vs. 1 204±545 mL, P=0.541; 6.1±3.7 d vs. 6.4 ±5.1 d, P=0.321). The incidence of postoperative complications (postoperative atelectasis, pulmonary infection, pleural effusion and anastomotic leakage) in the SMD group was not significantly different from that in the CMD group (10.6% vs. 6.1%, P=0.712; 4.3% vs. 10.2%, P=0.656; 6.4% vs. 12.2%, P=0.121; 2.1% vs. 4.1%, P=0.526). The numerical rating scale (NRS) pain scores on the first to the fifth day after surgery and during extubation in the SMD group were significantly lower than those in the CMD group (3.2±2.1 vs. 5.1±2.4, P=0.041; 2.8±0.6 vs. 4.8±1.4, P=0.015; 2.1±0.4 vs. 4.5±0.4, P=0.019; 1.7±0.7 vs. 4.0±0.8, P=0.004; 1.8±0.7 vs. 3.2±1.2, P=0.006; 1.4±0.2 vs. 2.5±3.4, P=0.012). The VAS comfort scores in the SMD group were significantly lower than those in the CMD group (3.6±1.7 vs. 6.6±3.7, P=0.018; 2.9±2.0 vs. 5.1±3.4, P=0.007; 2.1±1.4 vs. 5.5±2.4, P=0.004; 3.0±0.9 vs. 4.6±3.8, P=0.012; 1.8±1.1 vs. 4.2±2.7, P=0.003; 2.4±3.2 vs. 5.3±1.7, P=0.020).ConclusionThe clinical effect of single mediastinal drainage tube in thoracoscopic resection of esophageal carcinoma is similar to that of both mediastinal drainage tube and closed thoracic drainage tube, but it can significantly improve the comfort of the patients.
ObjectiveTo assess the safety of the removal of pericardial and mediastinal drain within different drainage volume after cardiac valvular replacement surgery.MethodsBetween July 2013 and July 2017, 201 patients with rheumatic heart disease (CHD) were treated with valve replacement in our hospital, including 57 males and 144 females, aged 15 to 72 years. They were divided into two groups according to the amount of 24-h drainage before the drain removal: a group one with 24-h drainage volume≤50 ml (n=127) and a group two with 24-h drainage volume>50 ml (n=74). The postoperative hospital stay and the incidence of severe complications between the two groups were compared.ResultsThere was no difference between the two groups in the baseline information or the incidence of severe pericardial effusion and tamponade, while the group two tended to have a shorter length of hospital stay after surgery (8.0 d vs. 7.5 d, P=0.013).ConclusionIn CHD patients undergoing valvular surgery, compared with a relatively low amount of drainage before the drain removal, drawing the tube at a greater amount of drainage (24-h drainage volume>50 ml) will shorten the length of hospital stay after cardiac surgery while incidence of severe complications remains the same.