Background: Postoperative prolonged air leaks is one of the most common complications secondary to pulmonary resections. Digital drainage system (DDS) is considered as an accurate and objective device which has been found to be comfortable and well tolerated by patients, economical as well. The aim of this study is to explore the application of DDS in patients with postoperative refractory prolonged air leaks after pulmonary surgery.
Methods: Prolonged air leak (PAL) is defined as air leaks lasting for more than 5 d after video-assisted surgery or more than 7 d after thoracotomy. Postoperative refractory prolonged air leak is defined as a kind of air leak lasting for twice than PAL with grade 2 or 3 air leak, or air leak with severe complications such as subcutaneous or mediastinal emphysema in our study. A total of 8 patients who had postoperative refractory prolonged air leaks after pulmonary resection were treated with digital drainage system combined with pleurodesis from January to December in 2016 in Department of Thoracic Surgery, Shanghai Pulmonary Hospital. All the relevant clinical data of patients were collected for analysis.
Results: In our study, 6 patients accepted lobectomy, the other 2 patients underwent segmentectomy. The average air leak and chest tube duration of the patients with postoperative refractory prolonged air leaks after pulmonary resection was (17.3±5.1) d. The average postoperative DDS duration was (5.6±3.7) d. The mean drainage volume of the patients was (2,615.6±1,741.2) mL and (935.0±242.7) mL before and after the application of DDS. The average length of hospital stay was (18.1±5.0) d.
Conclusions: It is safe and feasible to apply digital drainage system to patients with postoperative refractory prolonged air leaks after pulmonary resection. Compared with the conventional drainage system, digital drainage system is more accurate and objective which can offer a larger suction pressure and promote lung recruitment maneuver for pleurodesis, shortening the drainage time and length of hospital stay.
背景与目的 术后持续性肺漏气是肺部手术后最常见的并发症之一。数字化胸腔引流系统（digital drainage system, DDS）被认为具有准确、客观、舒适、患者耐受性好、经济等优点。本研究旨在总结DDS用于肺部手术后难治性持续性大量漏气的临床疗效。方法 术后5天和7天分别是胸腔镜和开胸术后持续性肺漏气（prolonged air leak, PAL）的界限；本研究将难治性持续性大量漏气定义为达到PAL时间2倍及以上且漏气持续达2度以上，可伴有明显皮下气肿或纵隔气肿等相关并发症。2016年1月-2016年12月间，应用数字化胸腔引流系统结合胸膜固定术治疗符合上述标准的病例共8例，收集相关临床资料并总结分析。结果 本组病例中肺叶切除术6例，肺段切除2例。平均术后持续漏气（17.3±5.1）d，DDS平均使用时间（5.6±3.7）d。平均术后引流量（3,550.6±1,881.1）mL。应用DDS前后的平均引流量为（2,615.6±1,741.2）mL和（935.0±242.7）mL。平均住院时间（18.1±5.0）d。结论 数字化胸腔引流系统用于肺部手术后难治性持续性大量漏气安全可行，可提供更大的负压吸引值，从而促使患肺复张为后继的胸膜固定术创造条件，并缩短引流天数和住院时间。.
Keywords: Digital drainage system; Postoperative refractory prolonged air leaks; Pulmonary resection; Surgery.