本文選題：胸腔鏡　切入點(diǎn)：單操作孔　出處：《蘇州大學(xué)》2015年碩士論文

【摘要】：目的:探討單操作孔電視胸腔鏡(video-assisted thoracoscopic surgery,VATS)肺癌根治術(shù)后胸腔引流管的拔除指征。方法:將2012年8月至2014年2月蘇州大學(xué)附屬第一醫(yī)院胸外科168例行單操作孔VATS肺癌根治術(shù)的患者隨機(jī)分為A、B、C三組,分別以胸腔引流液量≤150 ml/d、300 ml/d、450 ml/d為拔管指征。所有患者術(shù)后24 h行胸部X線檢查肺復(fù)張及胸腔積液情況。觀察和記錄引流液量及性狀。記錄患者體溫變化,行血常規(guī)及血生化檢查。根據(jù)改良的視覺模擬疼痛評分法,大于4分者根據(jù)情況予以肌注鹽酸哌替啶1 mg/kg,患者出院后隨訪1周。觀察記錄3組術(shù)后引流管拔除時(shí)間、術(shù)后住院時(shí)間、術(shù)后VAS疼痛評分、術(shù)后止痛藥物用量、術(shù)后并發(fā)癥(包括發(fā)熱、呼吸困難、心律失常、皮下氣腫、胸膜殘腔、胸腔積液)的發(fā)生率、胸腔穿刺率,再次置管率。結(jié)果:A、B、C三組的術(shù)后病理類型均包括鱗癌、腺癌和其他非小細(xì)胞肺癌,差異無統(tǒng)計(jì)學(xué)意義(p=0.957)。三組的淋巴結(jié)清掃數(shù)目分別為11.9±1.3,12.4±1.2和12.6±1.0顆,差異無統(tǒng)計(jì)學(xué)意義(p=0.844)。三組患者還分別比較了平均年齡、性別、手術(shù)時(shí)間以及胸管數(shù)目,結(jié)果顯示差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。B、C組患者的術(shù)后引流時(shí)間較A組患者的短,且差異有統(tǒng)計(jì)學(xué)意義(P0.05);C組患者的術(shù)后引流時(shí)間較B組更短,差異有統(tǒng)計(jì)學(xué)意義(P=0.036)。B、C兩組的術(shù)后住院時(shí)間分別為4.8±1.1、4.3±1.2天,差異無統(tǒng)計(jì)學(xué)意義(P=0.066)。A、B、C三組的平均鹽酸哌替啶用量分別為370.5±42.6、248.9±33.3、226.1±32.7 mg,A組用量較B、C組大,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。B組和C組在VAS總評分方面的差異無統(tǒng)計(jì)學(xué)意義(P0.05),但A組的VAS總評分大于B、C組(P0.05)。全組患者共有13例發(fā)生胸腔積液,其中2例來自B組且1例需行胸腔穿刺抽液,另外11例均來自C組,其中10例需行胸腔穿刺或者再次置管引流。C組胸腔穿刺的患者數(shù)目明顯多于A、B組,且差異有統(tǒng)計(jì)學(xué)意義(P0.05),三組之間胸腔再次置管的差別無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:以胸腔引流液量閾值為300 ml/d時(shí)拔除引流管與傳統(tǒng)的以胸腔引流液量閾值為150 ml/d時(shí)拔除引流管相比,可明顯縮短患者引流時(shí)間、術(shù)后住院時(shí)間、降低患者術(shù)后住院費(fèi)用、減低患者的疼痛感覺,且并不增加并發(fā)癥及胸腔穿刺的發(fā)生率,而以胸腔引流液量閾值為450 ml/d時(shí)拔除引流管也是可行的,但可能會增加患者拔管后胸腔積液的發(fā)生率及行胸腔穿刺術(shù)的風(fēng)險(xiǎn),安全性有所下降。
[Abstract]:Objective: to investigate the indication of extubation of thoracic drainage tube after video-assisted thoracoscopic Surgeryus (VATS) radical resection of lung cancer.Methods: from August 2012 to February 2014, 168 patients undergoing single hole VATS radical resection of lung cancer in the first affiliated Hospital of Suzhou University were randomly divided into three groups. The drainage volume of thoracic cavity was less than 150ml / d ~ (3) ml / d ~ (#number0#) / d ~ (450) ml/d as the indication of extubation.All patients underwent chest X-ray examination 24 hours after operation of pulmonary reexpansion and pleural effusion.The quantity and characteristics of drainage fluid were observed and recorded.The changes of body temperature, blood routine and blood biochemical examination were recorded.According to the improved visual analogue pain score, those who scored more than 4 were given 1 mg / kg pethidine hydrochloride intramuscularly. The patients were followed up for 1 week after discharge.Postoperative drainage tube extraction time, postoperative hospitalization time, postoperative VAS pain score, postoperative analgesic dosage, postoperative complications (including fever, dyspnea, arrhythmia, subcutaneous emphysema, pleural cavity) were observed and recorded.The incidence of pleural effusion, the rate of thorax puncture, and the rate of re-catheterization.Results the postoperative pathological types of the three groups included squamous cell carcinoma, adenocarcinoma and other non-small cell lung cancer (NSCLC). There was no significant difference between the three groups (p0. 957).The number of lymph node dissection in the three groups were 11.9 鹵1.3, 12.4 鹵1.2 and 12.6 鹵1.0, respectively. The difference was not statistically significant.The mean age, sex, operation time and the number of thoracic ducts were also compared among the three groups. The results showed that there was no significant difference in postoperative drainage time between group A and group A.The postoperative drainage time in group P0.05 was shorter than that in group B, and the postoperative hospital stay was 4.8 鹵1.1 鹵1.2 days.宸紓鏃犵粺璁″鎰忎箟(P=0.066).A,B,C涓夌粍鐨勫鉤鍧囩洂閰稿搶鏇垮暥鐢ㄩ噺鍒嗗埆涓，

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