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Elmezayen A, Osama A, Said Elbendary A, Abdelbar A. Comparison of single and double chest drains following pulmonary lobectomy. PLoS One 2025; 20:e0319077. [PMID: 40338841 PMCID: PMC12061084 DOI: 10.1371/journal.pone.0319077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2024] [Accepted: 01/27/2025] [Indexed: 05/10/2025] Open
Abstract
BACKGROUND Chest tubes are commonly used to empty the chest cavity after pulmonary lobectomy. Although two drains have traditionally been used to guarantee proper air and fluid evacuation, they frequently cause patients more pain and lengthen their hospital stays. This study set out to compare the effectiveness of using a single chest drain versus using two chest drains after a pulmonary lobectomy. METHODS This retrospective trial was performed on 50 patients aged ≥18 years, both sexes, scheduled for Video-Assisted Thoracic Surgery (VATS) lobectomy. Patients were divided into two equal groups: Group S: single chest tube was used and Group D: double chest tubes were used. RESULTS The duration of drainage was 3.32 ± 0.69 days in group S and was 4.2 ± 1.29 days in group D (P < 0.05). The amount of drainage was 593.64 ± 45.94 ml in group S and was 910.04 ± 71.42 ml in group D (P < 0.05). Assessment of the pain using the visual analog scale on second day was insignificantly different between both groups and was significantly lower at the second postoperative week in group S than in group D (P = 0.005). Length of hospital stays and complications (pneumonia, re-drainage, and persistent air leak (> 7 days)) were insignificantly different between both groups. CONCLUSIONS The effectiveness of inserting one chest tube following a pulmonary lobectomy is comparable to that of inserting two tubes. Furthermore, employing a single tube is more advantageous than two tubes, as it is associated with lower postoperative pain, duration and amount of drainage.
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Affiliation(s)
- Ahmed Elmezayen
- Cardiothoracic Surgery Department, Faculty of Medicine, Tanta University, Tanta, Egypt. Basildon University Hospital, London, United Kingdom
| | - Ahmed Osama
- Pediatrics Department, Mabara Hospital, Ministry of Health, Tanta, Egypt
| | - Amal Said Elbendary
- Clinical Pathology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Abdelrahman Abdelbar
- Cardiothoracic Surgery Department, Manchester University NHS Foundation Trust, Manchester, United Kingdom
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Liang Q, He B, Zhang B, Zhang Z. A case report of a bleeding case after removal of chest drain after lung surgery. Medicine (Baltimore) 2024; 103:e39279. [PMID: 39213198 PMCID: PMC11365689 DOI: 10.1097/md.0000000000039279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Revised: 07/21/2024] [Accepted: 07/23/2024] [Indexed: 09/04/2024] Open
Abstract
RATIONALE Postoperative bleeding after lobectomy is relatively rare. By analyzing and discussing the case history and management of hemorrhagic shock caused by chest tube removal after lobectomy, we can achieve the purpose of preventing postoperative bleeding after thoracic surgery and reducing postoperative complications, which can help avoid the risk of second surgery, shorten the patient's hospital stay, reduce the cost of medical care, and improve the patient's quality of life. PATIENT CONCERNS A case of bleeding from tube removal after lobectomy. The bleeding from chest drain removal on the 3rd day after thoracoscopic lobectomy resulted in hemorrhagic shock, which was stopped by thoracoscopic exploration again under active antishock, and there was no recurrence of bleeding after the operation, and the patient was discharged from the hospital after chest drain removal. DIAGNOSES Enhanced computed tomography of the chest revealed a space-occupying lesion in the middle lobe of the right lung. INTERVENTIONS Thoracoscopy was performed again on the condition of active anti-shock. OUTCOMES On the third day after thoracoscopic lobectomy, the patient underwent removal of the chest drain and subsequently experienced hemorrhagic shock. Given the necessity of maintaining anti-shock measures, the patient was subjected to a second thoracoscopic exploration with the objective of halting the hemorrhage. Following this procedure, the patient did not present with any further episodes of bleeding. Subsequently, a new chest drain was placed, and once the drainage flow had diminished to an acceptable level, the chest drain was removed. The patient subsequently made a full recovery and was discharged from the hospital. LESSONS Even if the safely inserted drain tube is removed, the thoracic surgeon must be aware of possible vascular bleeding.
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Affiliation(s)
- Qichen Liang
- School of Clinical Medicine, Jining Medical College, Jining, Shandong, P. R. China
| | - Baoyu He
- Department of Laboratory Medicine, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, P. R. China
| | - Bin Zhang
- Department of Laboratory Medicine, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, P. R. China
| | - Ziteng Zhang
- Department of Thoracic Surgery, Affiliated Hospital of Jining Medical University, Jining, Shandong, P. R. China
- Department of Thoracic Surgery, Qinghai Red Cross Hospital, Xining, Qinghai, P. R. China
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Kong XL, Zhang Y, Jia Y, Ni BX, Wang M, Jin XY, Xu H, Xu SD. Safety of one 8.5-Fr pigtail catheter for postoperative continuous open gravity drainage after uniportal video-assisted thoracoscopic surgery pneumonectomy. J Cardiothorac Surg 2024; 19:457. [PMID: 39026246 PMCID: PMC11256783 DOI: 10.1186/s13019-024-02894-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/15/2024] [Indexed: 07/20/2024] Open
Abstract
OBJECTIVES Uniportal video-assisted thoracoscopic surgery pneumonectomy (U-VATS-P) is feasible and safe from a perioperative standpoint. How to choose the proper chest tube and drainage method is important in enhanced recovery after surgery (ERAS) protocols. In this study, we aimed to assess the safety of one 8.5-Fr (1Fr = 0.333 mm) pigtail catheter for postoperative continuous open gravity drainage after U-VATS-P. METHODS We retrospectively reviewed a single surgeon's experience with U-VATS-P for lung cancer from May 2016 to September 2022. Patients were managed with one 8.5-Fr pigtail catheter for postoperative continuous open gravity drainage after U-VATS-P. The clinical characteristics and perioperative outcomes of the patients were retrospectively analyzed. RESULTS In total, 77 patients had one 8.5-Fr pigtail catheter placed for postoperative continuous open gravity drainage after U-VATS-P for lung cancer. The mean age was 60.9±7.39 (40-76) years; The mean FEV1 was 2.1±0.6 (l/s), and the mean FEV1% was 71.2±22.7. The median operative time was 191.38±59.32 min; the mean operative hemorrhage was 109.46±96.56 ml; the mean duration of postoperative chest tube drainage was 6.80±2.33 days; the mean drainage volumes in the first three days after operation were 186.31±50.97, 321.97±52.03, and 216.44±35.67 ml, respectively; and the mean postoperative hospital stay was 7.90±2.58 days. No patient experienced complications resulting from chest tube malfunction. Ten patients experienced minor complications. One patient with nonlife-threatening empyema and bronchopleural fistula required short rehospitalization for anti-inflammatory therapy and reintubation. Three patients with chylothorax were treated with intravenous nutrition. Four patients had atrial fibrillation that was controlled by antiarrhythmic therapy. Two patients had more thoracic hemorrhagic exudation after the operation, which was found in time and was cured effectively, so they were discharged from the hospital uneventfully after early hemostatic therapy and nutritional support. CONCLUSIONS All patients in this study received early postoperative rehabilitation, and the rate of relevant complications was low. We therefore recommend a single 8.5-Fr pigtail catheter for postoperative continuous open gravity drainage as an effective, safe and reliable drainage method for the management of U-VATS-P.
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Affiliation(s)
- Xiang-Long Kong
- Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, No. 150, Hapin Road, Harbin, 150081, China
| | - Yue- Zhang
- Department of Area B, ICU, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yu- Jia
- Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, No. 150, Hapin Road, Harbin, 150081, China
| | - Bo-Xiong Ni
- Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, No. 150, Hapin Road, Harbin, 150081, China
| | - Mingyu- Wang
- Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, No. 150, Hapin Road, Harbin, 150081, China
| | - Xiang-Yuan Jin
- Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, No. 150, Hapin Road, Harbin, 150081, China
| | - Hai Xu
- Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, No. 150, Hapin Road, Harbin, 150081, China
| | - Shi-Dong Xu
- Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, No. 150, Hapin Road, Harbin, 150081, China.
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Wang L, Dong Y, Ji Y, Song W, Cheng C, Yang M, Che G. Clinical outcome and risk factors for subcutaneous emphysema in patients with lung cancer after video-assisted thorascopic surgery. Front Surg 2022; 9:956431. [PMID: 36117818 PMCID: PMC9478373 DOI: 10.3389/fsurg.2022.956431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/26/2022] [Indexed: 11/24/2022] Open
Abstract
Background and purpose With the clinical application of minimally invasive surgery and concept of enhanced recovery after surgery, the incidence of postoperative complications in lung cancer patients has been significantly reduced. However, postoperative subcutaneous emphysema (SE) becomes the main factor affecting the early discharge of patients. The aim of this study was to analyze the clinical outcome and risk factors for postoperative SE in lung cancer patients. Methods The clinical data of 414 lung cancer patients who were admitted to the Department of Thoracic Surgery, West China Hospital, Sichuan University from September 2021 to December 2021 were prospectively collected. The incidence, severity and treatment of patients who had SE, surgery approach, application of drainage tube and clinical information were analyzed. Results The incidence rate of postoperative SE in patients with lung cancer was 33.09% (137/414) and mild cases accounted for the vast majority (30.19%, 125/414). Multivariate analysis indicated that male [odds ratio (OR) = 2.247, P = .014] and advanced age (OR = 1.021, P = .043) were main risk factors for postoperative SE in patients with lung cancer. Conservative treatment was the main treatment option for SE (98.5%, 135/137). The average hospital stay in the subcutaneous emphysema group (5.49 ± 4.41 days) was significantly longer than that in the non-subcutaneous emphysema group (4.44 ± 3.32 days) (P = .014) and no significant statistical difference in the average total hospital cost between the two groups (7,798.31 ± 1,414.85$ vs. 7,501.14 ± 1,605.18$, P = .072). Conclusion Postoperative SE in patients with minimally invasive lung cancer is mainly mild, and conservative treatment is appropriate for most cases.
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Affiliation(s)
- Lei Wang
- Department of Thoracic Surgery, West China School of Nursing, Sichuan University, Chengdu, China
| | - Yingxian Dong
- Lung Cancer Center, West-China Hospital, Sichuan University, Chengdu, China
| | - Yanli Ji
- Department of Thoracic Surgery, West China School of Nursing, Sichuan University, Chengdu, China
| | - Wenpeng Song
- Lung Cancer Center, West-China Hospital, Sichuan University, Chengdu, China
| | - Chao Cheng
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Mei Yang
- Department of Thoracic Surgery, West China School of Nursing, Sichuan University, Chengdu, China
| | - Guowei Che
- Lung Cancer Center, West-China Hospital, Sichuan University, Chengdu, China
- Correspondence: Guowei Che
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Govindraj R, McPherson I, Hawkins R, McLellan M, Hannah A, Asif M, Kirk AJ. Is there an ideal position and size of chest drain following anatomical lung resection? Surgeon 2021; 20:321-327. [PMID: 34600827 DOI: 10.1016/j.surge.2021.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 07/24/2021] [Accepted: 08/09/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Chest drains are placed after surgery to enable lung re-expansion. However, there remains little guidance on optimal placement. This study aims to identify the ideal size and position for chest drain insertion with regards to post-operative outcomes. METHODS 383 patients undergoing lobectomy in 1-year had their chest drain size and x-ray position noted (1 (apical), 2 (mid-zone) or 3 (basal)). Primary outcome was residual air space on immediate post-operative x-ray. Secondary outcomes were length of drain in situ (<72 versus ≥72 h), persisting pleural effusion, surgical emphysema, post-operative pneumonia (POP), and length of hospital stay (<5 versus ≥5 days). Fisher's exact analysis for the primary outcome and binary logistic regression analysis for all outcomes were used. Results presented as odds ratios (OR±95%CI). RESULTS Univariate analysis for residual air space showed increased risk in area 2 (OR = 1.61, p = 0.041) and 3 (OR = 2.59, p = 0.0043) compared with area 1. Multivariate analysis for residual air space showed increased risk in area 2 (OR = 2.39, p < 0.001) and 3 (OR = 2.86, p < 0.001) compared with area 1. Drain size had no impact on residual air space in univariate or multivariate analysis. Multivariate analysis showed area 2 drains remained in situ for >72 h (OR = 1.49, p = 0.017), had persisting effusions (OR = 2.03, p = 0.004) and POP (OR = 2.10, p = 0.023) compared with area 1. This risk is magnified further for drains in area 3. Drains ≥28F had reduced risk of surgical emphysema (OR = 0.23, p = 0.027) in multivariate analysis. CONCLUSION A ≥28F, apical chest drain reduces the risk of post-operative complications, allowing early removal and discharge.
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Affiliation(s)
- Rohith Govindraj
- Department of Thoracic Surgery, Golden Jubilee National Hospital, Clydebank, UK
| | - Iain McPherson
- Department of Thoracic Surgery, Golden Jubilee National Hospital, Clydebank, UK.
| | - Rosalyn Hawkins
- Department of Thoracic Surgery, Golden Jubilee National Hospital, Clydebank, UK
| | - Morag McLellan
- Department of Thoracic Surgery, Golden Jubilee National Hospital, Clydebank, UK
| | - Alexander Hannah
- Department of Thoracic Surgery, Golden Jubilee National Hospital, Clydebank, UK
| | - Mohammed Asif
- Department of Thoracic Surgery, Golden Jubilee National Hospital, Clydebank, UK
| | - Alan Jb Kirk
- Department of Thoracic Surgery, Golden Jubilee National Hospital, Clydebank, UK
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Yang J, Huang W, Li P, Hu H, Li Y, Wei W. Single-port VATS combined with non-indwelling drain in ERAS: a retrospective study. J Cardiothorac Surg 2021; 16:271. [PMID: 34565415 PMCID: PMC8474895 DOI: 10.1186/s13019-021-01657-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 09/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background We investigated single-port video-assisted thoracoscopic surgery (VATS) combined with a postoperative non-indwelling drain in enhanced recovery after surgery (ERAS). Methods The clinical data of 127 patients who underwent double- and single-port VATS from January 2018 to December 2019 were analyzed retrospectively. The groups constituted 71 cases undergoing double-port and 56 cases undergoing single-port VATS (30 cases in the indwelling drain group and 26 cases in the non-indwelling drain group). The incidence of postoperative complications, pain scores, and postoperative hospital stay were compared between the two groups. Results Compared with the double-port group, the single-port group had shorter postoperative hospital stays and lower pain scores on the first and third postoperative days (P < 0.05). Pain scores on the first and third days were lower in the single-port non-indwelling drain group than in the single-port indwelling drain group (P < 0.05), and the postoperative hospitalization time was significantly shorter in the single-port group (P < 0.05). However, there was no significant difference between the two groups for operation time, incidence of complications, and pain scores 1 month after operation (P > 0.05). Conclusions The combination of single-port VATS with a non-indwelling drain can relieve postoperative pain, help patients recover quickly, and is in accordance with ERAS.
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Affiliation(s)
- Jiantian Yang
- Department of Cardiothoracic Surgery, Huizhou Municipal Central Hospital, 41 Eling North Road, Huizhou, 516001, China
| | - Wencong Huang
- Department of Cardiothoracic Surgery, Huizhou Municipal Central Hospital, 41 Eling North Road, Huizhou, 516001, China
| | - Peijian Li
- Department of Cardiothoracic Surgery, Huizhou Municipal Central Hospital, 41 Eling North Road, Huizhou, 516001, China
| | - Huizhen Hu
- Department of Pathology, Huizhou No. 1 Maternal and Child Care Service Center, Huizhou, 516007, China
| | - Yongsheng Li
- Department of Cardiothoracic Surgery, Huizhou Municipal Central Hospital, 41 Eling North Road, Huizhou, 516001, China
| | - Wei Wei
- Department of Cardiothoracic Surgery, Huizhou Municipal Central Hospital, 41 Eling North Road, Huizhou, 516001, China.
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Broschewitz J, Metelmann I, Steinert M, Krämer S. [Thoracic Surgery Without Chest Tube: The Current Situation in Germany]. Zentralbl Chir 2021. [PMID: 34225380 DOI: 10.1055/a-1502-8210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Over the last decades, several techniques have been implemented to reduce the invasiveness of thoracic surgery. Omitting chest tubes can lead to less postoperative pain and a shorter length of hospital stay. This study examines the extent to which German surgeons use the tubeless technique and what experience they have had with it. MATERIALS AND METHODS We conducted a nationwide survey, supported by the German Society of Thoracic Surgery (DGT). A digital questionnaire was sent to all leading thoracic surgeons with DGT membership between July and September 2020. RESULTS 63 of 161 surgeons (39%) returned the questionnaires. The tubeless technique was used in 1.9% of thoracic surgery procedures performed last year. 59% of hospitals have implemented the technique; 24% of them also performed lung resections that way. The majority of respondents (79%) believe that the tubeless technique causes less postoperative pain; 16% see no advantage. Pleural effusion was ranked as the most important contraindication (76%). All participating surgeons agree that the absence of an air fistula is a prerequisite for performing lung resections using the tubeless technique - commonly checked by an underwater leak test (73%), and/or with a digital drainage system (53%), partially under pressure controlled ventilated lungs. Almost half of the respondents (46%) have not observed any complications using the tubeless technique. CONCLUSION Most German thoracic surgeons consider the tubeless technique safe and advantageous over the conventional technique. However, the case load is low and only 59% of the surgeons surveyed have experience with this technique. Randomised clinical trials concerning selection criteria and the procedural pathway may help increase the use.
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Affiliation(s)
- Johannes Broschewitz
- Klinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Deutschland
| | - Isabella Metelmann
- Klinik und Poliklinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, Deutschland
| | - Matthias Steinert
- Klinik und Poliklinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, Deutschland
| | - Sebastian Krämer
- Klinik und Poliklinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, Deutschland
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Song Y, Zheng C, Zhou S, Cui H, Wang J, Wang J, Wang W, Liu L, Liu J. The application analysis of 8F ultrafine chest drainage tube for thoracoscopic lobectomy of lung cancer. J Cardiothorac Surg 2021; 16:104. [PMID: 33882980 PMCID: PMC8059218 DOI: 10.1186/s13019-021-01479-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 04/05/2021] [Indexed: 11/17/2022] Open
Abstract
Background Currently, thoracoscopic lobectomy is widely used in clinical practice, and postoperative placement of ultrafine drainage tube has advantages of reducing postoperative pain and accelerating postoperative recovery in patients. This study aimed to investigate the feasibility and safety of placement of 8F ultrafine chest drainage tube after thoracoscopic lobectomy and its superiority over traditional 24F chest drainage tube. Methods A retrospective data analysis was conducted in 169 patients who underwent placement of 8F ultrafine chest drainage tube or 24F chest drainage tube with thoracoscopic lobectomy for lung cancer from January 2018 to December 2019. Propensity score matching (PSM) was used to reduce bias between the experimental group and the control group. After PSM, 134 patients (67 per group) were enrolled. The drainage time, the total drainage volume, postoperative hospital stay, postoperative pain score and postoperative complication of both groups were analyzed and compared. Results Compared to group B, group A had lower pain scores on postoperative days 1, 2 and 3 (3.72 ± 0.65point vs 3.94 ± 0.67point, P = 0.027; 2.72 ± 0.93point vs 3.13 ± 1.04point, P = 0.016; and 1.87 ± 0.65point vs 2.39 ± 1.22point, P = 0.005), shorter drainage time (4.25 ± 1.79d vs 6.04 ± 1.96d, P = 0.000), fewer drainage volume (1100.42 ± 701.57 ml vs 1369.39 ± 624.25 ml, P = 0.021); and shorter postoperative hospital stay (8.46 ± 2.48d vs 9.37 ± 1.70d, P = 0.014). Postoperative complications such as subcutaneous emphysema, pulmonary infection, atelectasis, chest tube reinsertion and intrathoracic hemorrhage showed no differences between both groups (P > 0.05). Conclusion Compared with 24F chest drainage tube, the application of an 8F ultrafine chest drainage tube after thoracoscopic lobectomy has significantly shortened the drainage time, reduced the total drainage volume, reduced the postoperative pain degree, shortened the hospital day, and effectively detected postoperative intrathoracic hemorrhage. So, it is considered as an effective, safe and reliable drainage method.
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Affiliation(s)
- Yongbin Song
- Graduate School, Hebei Medical University, 361 Zhongshan East Road, Shijiazhuang, 050051, Hebei Province, People's Republic of China.,Department of Thoracic Surgery, Hebei General Hospital, 348 West He-Ping Road, Shijiazhuang, 050051, Hebei Province, People's Republic of China
| | - Chong Zheng
- Department of Thoracic Surgery, Hebei General Hospital, 348 West He-Ping Road, Shijiazhuang, 050051, Hebei Province, People's Republic of China.,Graduate School, Hebei North University, 11 Diamond South Road, High-tech Zone, Zhangjiakou, 075000, Hebei Province, People's Republic of China
| | - Shaohui Zhou
- Department of Thoracic Surgery, Hebei General Hospital, 348 West He-Ping Road, Shijiazhuang, 050051, Hebei Province, People's Republic of China
| | - Hongshang Cui
- Department of Thoracic Surgery, Hebei General Hospital, 348 West He-Ping Road, Shijiazhuang, 050051, Hebei Province, People's Republic of China
| | - Jincong Wang
- Ningbo University Medical School, 818 Fenghua Road, Jiangbei District, Ningbo, 315000, Zhejiang Province, People's Republic of China
| | - Jianxun Wang
- Department of Thoracic Surgery, Hebei General Hospital, 348 West He-Ping Road, Shijiazhuang, 050051, Hebei Province, People's Republic of China.,Graduate School, Hebei North University, 11 Diamond South Road, High-tech Zone, Zhangjiakou, 075000, Hebei Province, People's Republic of China
| | - Wenhao Wang
- Department of Thoracic Surgery, Hebei General Hospital, 348 West He-Ping Road, Shijiazhuang, 050051, Hebei Province, People's Republic of China
| | - Lijun Liu
- Department of Thoracic Surgery, Hebei General Hospital, 348 West He-Ping Road, Shijiazhuang, 050051, Hebei Province, People's Republic of China
| | - Junfeng Liu
- Department of Thoracic Surgery, Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital, 12 Jiankang Road, Shijiazhuang, Hebei Province, 050011, People's Republic of China.
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