| Object:To evaluate the clinical apply value of 16 Fr gastric tube alternativing routine thoracic closed drainage tube after lobectomy in VATS.(:Video-assisted thoracoscopic surgery)Methods:101 cases ofpatients by Lung Video-assisted thoracoscopic surgery(LVATS)were randomly divided into A,B two groups,which were from the two thoracic surgery Departments of our hospital in 2016 July to September 2017.Group A are make of 50 cases patients who were operated in the single-port VATS and a 16 Fr one-time gastric tube was placed in the chest cavity by the surgery incision.Group B are constituted by 51 cases patients who were operated in the single opertional-port VATS and a28 Fr PVC routine thoracic closed drainage tube(28 Fr PVC tube)was placed in the chest cavity through observation hole.All patients were electrocardiogram monitored for 24 hours after operation,closely monitored the vital signs(blood pressure,heart rates,body temperate,respiration rates etc),and underwent X-ray examination on the next day and every 3 days.Pain relief was performed by PCEA(Patient-controlled epidural analgesic)on day 1 after surgery,and in the second day and later,according to the VAS pain score,VAS was greater than 4 and non-steroidal(niesulus dispersive tablet)pain drugs was eaten.After the operation,the thoracic drainage tube patency of the two groups was observed carefully in order to keep residual Pulmonary expansion condition.Daily average bulk of thoracic drainage(ml/d).Average days when closed thoracic drainage tube keep in the pleural cavity.Pain score were writed according to evaluating VAS.The degree of inflammation around the tissue of the drainage tube,whether there was numbness,or whether the surrounding tissue was hard.And the incidence of postoperative complications(suchas,atelectasis,obstruction of drainage tube,pleural effusion,subcutaneous emphysema,etc)and re-catheterization rate.Results:Two groups of patients with gender,age,BMI,operation time,cleaning the number of sets of lymph nodes,intraoperative blood seeped,surgical removal of the parts(the upper,middle or lower lung)and pathological types(adenocarcinoma and squamous cell carcinomas and other malignant lesion,the non-malignant lesions),results showed that there were no statistically significant difference(P>0.05).There were 1 case in group A and 3 cases in group B occuring with PAF(Paroxysmal atrial fibrillation),by intravenous infusion of amiodarone injection,who were all converted to NSR(normal sinus rhythm).On the first day after the operation,the chest X-ray examination was performed,and about 70% of the two groups of lungs were compressed,each of which had one case,both of which were closed with thoracic closed drainage in the second rib of the midclavicular line.The next day,the chest radiograph was re-examined,both groups had no subcutaneous emphysema and re-catheterization of pleural effusion.There were no significant difference of residual Pulmonary expansion(P=0.463)and thoracic drainage tube patency(P=0.472)between A and B groups statistically.Comparison between group A and group B,the volume of thoracic drainage were 200.09±61.08,244 ± 53.23ml/d respectively,and the z-value of the average days when closed thoracic drainage tube keep in the pleural cavity was-4.12,which indicated that the differences were statistically significant(P<0.05).The chi-square values of inflammation in the 2,4 and 7 days in the surrounding skin of the drainage tube were respectively 23.07,19.88,33.96,which stated that the differences were significant statistically(P<0.05).The z-value of the pain score in the 2,4 and 7 days were-3.69,-6.92,-6.0 respectively,and the chi-square values of pigmentation and numbness in the surrounding tissue of the drainage tube were respectively 29.97,18.53,which illustrated that the differences were significant statistically(P< 0.01).There were statistically significant differences inin terms of the hardness of the surrounding tissues of the drainage tube(P<0.05).Conclusion:After thoracoscopic lobectomy,using a disposable side-holes 16 Fr gastric tube instead of 28 Fr PVC tube to execute closed thoracic drainage,which is more convenient and economic on account of operation materials,while it not only has advantages of operating procedure and same drainage patency,but has less volume of thoracic drainage and shorter taking-tube time,as well as obviously more limited wound,less pains,inflammation,numbness,scarring,pigmentation and sclerosis in surrounding tissues,which is favor of promoting the healing of the incision and rapid recovery. |
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