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Randomized Trial of Modified Chest Tube Placement vs Routine Placement After Lung Resection

医学 胸导管 切除术 外科 全肺切除术 随机对照试验 放射科 内科学 气胸
作者
Tianxiang Yun,Yaoyun Zhang,Ao Liu,Yi Qu,Xiaofeng Sun,Zhe Wu,Chenyu Zhang,Kun Luan,Zipeng Wang,Zhaoyang Huang,Weiwei Su,Weihua Du,Wenjie Jiao
出处
期刊:The Annals of Thoracic Surgery [Elsevier BV]
卷期号:116 (5): 1013-1019
标识
DOI:10.1016/j.athoracsur.2023.04.031
摘要

Chest tube placement after pulmonary resection is usually considered a mandatory procedure. However, peritubular leakage of pleural fluid and intrathoracic air is frequent after surgery. Therefore, we separated the chest tube from the intercostal space as a modified placement strategy.Patients undergoing robotic and video-assisted lung resection were enrolled in this study at our medical center between February 2021 and August 2021. All patients were randomly divided into either the modified group (n = 98) or the routine group (n = 101). The incidence of peritubular leakage of pleural fluid and peritubular air leaking or entering after surgery were the primary end points of the study.A total of 199 patients were randomized. Patients in the modified group had lower incidence of peritubular leakage of pleural fluid (after surgery, 39.6% vs 18.4% [P = .001]; after chest tube removal, 26.7% vs 11.2% [P = .005]), lower incidence of peritubular air leaking or entering (14.9% vs 5.1% [P = .022]), and fewer dressing changes (5.02 ± 2.30 vs 3.48 ± 0.94 [P < .001]). In patients undergoing lobectomy and segmentectomy, the type of chest tube placement was associated with the severity of peritubular pleural fluid leakage (P < .05).The modified chest tube placement was safe and had better clinical efficacy than the routine type. The reduction of postoperative peritubular leakage of pleural fluid resulted in better wound recovery. This modified strategy should be popularized, especially in patients undergoing pulmonary lobectomy or segmentectomy.
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