Analysis Of Correlative Factors Of Tubeless After Thoracic Surgery

Objective:to explore the relative conditions of tubeless after thoracic surgeryMethods:a retrospective analysis was performed on the patients admitted to the thoracic tumor diagnosis and treatment center of Bethune first hospital of jilin university from May 2018 to August 2019,and the related patients of postoperative air leakage,chylothorax,intrathoracic hemorrhage and esophageal surgery were excluded.A total of 508 cases of pulmonary surgery and mediastinal surgery were collected.Retrospective analysis: patients with chest drainage volume less than or equal to 300 ml on the first day after surgery were defined as patients without chest drainage tube,while patients with chest drainage volume more than 300 ml on the first day after surgery were defined as patients requiring chest drainage tube.The correlation between tubeless and gender,age,smoking,hypertension,diabetes,chemotherapy,anesthesia time,blood loss,number of lymph node groups,number of lymph nodes and surgical type was analyzed retrospectively.SPSS 25.0 software was used to analyze the data.The measurement data with normal distribution were expressed as(±s),and the independent sample t test was used for inter-group comparison.N(%)was used for counting data,and 2 test was used for comparison between groups.Binary Logistic regression analysis was used for multivariate analysis.Test level(test)is 0.05.Results:a total of 508 patients were collected,and 330 patients(no tube group)had drainage volume less than or equivalent to 300 ml on the first day after surgery,and 178 patients(with tube group)had drainage volume more than 300 ml on the first day after surgery.There were 226 male patients and 282 female patients.142 smoking patients and 366non-smoking patients;There were 86 hypertensive patients and 422non-hypertensive patients.There were 45 diabetic patients and 463non-diabetic patients.There were 8 patients with neoadjuvant chemotherapy and 500 patients without neoadjuvant chemotherapy.All surgeries were thoracoscopic,including lobectomy in 15 cases,lobectomy and lymph node dissection in 258 cases,sublobectomy in 68 cases,sublobectomy and lymph node dissection in 132 cases,and mediastinal tumour resection in 35 cases.There were 234 cases of intraoperative pleural adhesion and 273 cases without intraoperative pleural adhesion.Age,no tube group(54.97±12.53)years old,tube group(59.83±9.05)years old;The anesthesia time was 158.58±37.43 minutes in the no tube group and 186.66±34.24 minutes in the tube group.The blood loss was 87.56±93.16 ml in the no tube group and 177.47±290.9 ml in the tube group.The number of lymph nodes was 3.58±2.62 in the no tube group and 4.70±2.25 in the tube group.The number of lymph nodes was 10.85±28.01 in the no tube group and 15.78±37.98 in the tube group.There were statistically significant differences in gender,smoking,chemotherapy,surgical type,adhesion,age,anesthesia time,blood loss and number of lymph nodes between the tube group and no tube group(P< 0.05),while there were no statistically significant differences in diabetes,hypertension and number of lymph nodes(P > 0.05).The results of multi-factor logistic regression analysis showed that gender,age,adhesion,anesthesia time,blood loss,and surgical type had statistical significance(P < 0.05).Independent risk factors of gender,male,adhesion,duration of anesthesia,blood loss and number of lymph nodes were:OR=1.96(1.109-3.465),1.832(1.133-2.961),1.010(1.002-1.017),1.003(1.000-1.005),and 1.203(1.150-1.259).;The risk of lobectomy was 5.422(1.263-23.271),the risk of sublobectomy and mediastinal tumour resection was 0.087(0.042-0.179),0.079(0.017-0.365),and there was no significant difference between lobectomy and lymph node dissection and sublobectomy and lymph node dissection.Conclusion:The need for postoperative tubeless in thoracic surgery patients needs to be individually analyzed.The risk of tubeless is increased in patients with the following factors: male,elderly patients,smoking patients,preoperative neoadjuvant therapy involving lymph node dissection,longer intraoperative anesthesia,more intraoperative blood loss,and chest adhesion.