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Analysis of Effect and Quality of Laparoscopic Cholecystectomy with Common Bile Duct Exploration，Built-in-Tube Drainage, and Primary Suture

ObjectiveTo compare and evaluate the effect and quality of T-tube drainage and bulit-in-tube drainage plus primary suture after laparoscopic cholecystectomy (LC). MethodsA clinical trial was taken in 79 cases with T-tube drainage (control group) and 62 cases with built-in-tube drainage (observation group). The treatment success rate, incidence of complications, bilirubin recovered time, length of stay, recuperation time, and treatment cost were measured and compared between the two groups. ResultsThere were no statistically significant differences between the two groups in treatment success rate, incidences of complications, and bilirubin recovered time of patients （Pgt;0.05）, while length of stay, recuperation time, and treatment cost of patients in observation group were significantly less than those in control group （Plt;0.05）. ConclusionsBuilt-in-tube drainage plus primary suture after LC and common bile duct exploration could achieve the same therapeutic effect as the traditional T-tube drainage with less length of stay, recuperation time, and treatment cost.

腹腔引流管拔除困难的原因分析及处理方法（附22例报道）

目的探讨腹腔引流管拔除困难的原因及临床处理方法。 方法回顾性分析笔者所在医院2003年7月至2015年5月期间22例腹部手术后腹腔引流管拔除困难患者的临床资料，总结分析其原因及处理方法。结果本组患者中引流管拔除时间为术后4～7 d者6例，7～10 d者16例。引流管拔除困难的原因1例为固定引流管的缝线从引流管穿过，4例为腹壁戳孔偏小，2例为引流管扭曲，9例为组织嵌入引流管内口或引流管侧孔（其中5例为纤维条索，4例为大网膜），6例无法确定原因。5例通过持续均匀用力牵引拔除，1例拆除缝合固定线拔除，8例通过旋转、来回牵拉或推送引流管拔除，8例应用持续重力牵引法拔除，无并发副损伤。 结论灵活应用各种方法来处理难以拔除的引流管，持续重力牵引法适宜于常规方法不能拔除的引流管。减少不必要的引流管放置，放置引流管时注意其细节和及时拔除引流管可避免引流管的拔除困难。

Clinical analysis of single mediastinal chest drains in perioperative period after thoracoscopic resection of esophageal carcinoma: A randomized controlled study

ObjectiveTo compare the clinical effect of single mediastinal drainage tube and both mediastinal drainage tube and closed thoracic drainage tube for the patients who received thoracoscopic radical resection of esophageal carcinoma.MethodsWe enrolled 96 esophageal carcinoma patients who received thoracoscopic radical resection from June 2016 to October 2018. Of them, 49 patients were indwelt with both mediastinal drainage tube and closed thoracic drainage tube (a chest & mediastinal drainage group, a CMD group) while the other 47 patients were indwelt with single mediastinal drainage tube (a single mediastinal drainage group, a SMD group). The total drainage volume, intubation time and incidence of postoperative complications (postoperative atelectasis, pulmonary infection, pleural effusion and anastomotic leakage) between the two groups were compared. The pain score and comfort score were also compared between the two groups.ResultsThe total drainage volume and intubation time in the SMD group were not significantly different from those in the CMD group (1 321±421 mL vs. 1 204±545 mL, P=0.541; 6.1±3.7 d vs. 6.4 ±5.1 d, P=0.321). The incidence of postoperative complications (postoperative atelectasis, pulmonary infection, pleural effusion and anastomotic leakage) in the SMD group was not significantly different from that in the CMD group (10.6% vs. 6.1%, P=0.712; 4.3% vs. 10.2%, P=0.656; 6.4% vs. 12.2%, P=0.121; 2.1% vs. 4.1%, P=0.526). The numerical rating scale (NRS) pain scores on the first to the fifth day after surgery and during extubation in the SMD group were significantly lower than those in the CMD group (3.2±2.1 vs. 5.1±2.4, P=0.041; 2.8±0.6 vs. 4.8±1.4, P=0.015; 2.1±0.4 vs. 4.5±0.4, P=0.019; 1.7±0.7 vs. 4.0±0.8, P=0.004; 1.8±0.7 vs. 3.2±1.2, P=0.006; 1.4±0.2 vs. 2.5±3.4, P=0.012). The VAS comfort scores in the SMD group were significantly lower than those in the CMD group (3.6±1.7 vs. 6.6±3.7, P=0.018; 2.9±2.0 vs. 5.1±3.4, P=0.007; 2.1±1.4 vs. 5.5±2.4, P=0.004; 3.0±0.9 vs. 4.6±3.8, P=0.012; 1.8±1.1 vs. 4.2±2.7, P=0.003; 2.4±3.2 vs. 5.3±1.7, P=0.020).ConclusionThe clinical effect of single mediastinal drainage tube in thoracoscopic resection of esophageal carcinoma is similar to that of both mediastinal drainage tube and closed thoracic drainage tube, but it can significantly improve the comfort of the patients.

鼓泡式改良左心引流管在心内直视手术中的应用

目的介绍鼓泡式改良左心引流管在心内直视手术中的应用。方法138例先天性心脏病、风湿性心瓣膜病及其它心脏疾病患者在心内直视手术中采用鼓泡式改良左心引流管进行左心减压引流。结果全部患者置入鼓泡式改良左心引流管顺利,拔除不困难,引流效果良好。结论鼓泡式改良左心引流管在负压吸引过程中侧孔不容易因吸附被软组织堵塞,引流效果可靠。

自制三腔三套引流管在胆道手术中的应用(附615例报告)

Preliminary experience of uniportal thoracoscopic surgery for benign thoracic diseases without chest tube placement after surgery

目的 介绍胸部良性疾病经单孔胸腔镜切除术后免胸腔引流管的临床经验。 方法 回顾性分析 2015 年 10 月至 2016 年 10 月我院胸外科 17 例行单孔胸腔镜手术患者的临床资料，其中男 9 例、女 8 例，年龄 33.8（17～58）岁。行肺大疱切除术 7 例，肺楔形切除术 9 例，交感神经烙断术 1 例。 结果 所有患者均经单孔胸腔镜手术有效切除，期间无中转开胸或再次开操作孔，术后不放置胸腔引流管，手术时间为（60.3±8.2）min，术中出血量为（15.2±5.1）ml，术后第 1 d、2 d、3 d 疼痛视觉模拟评分（VAS） 为 6.5±2.2，5.8±2.1，3.5±1.3，术后舒适度评分分别为 8.6±1.3，术后早期下床活动时间为（1.0±0.3）d，切口甲级愈合率 100.0%。17 例患者均无心律失常、肺部感染等并发症，术后随访 6 个月气胸均无复发。 结论 合理选择及严格基线评估，胸部良性疾病经单孔胸腔镜切除术后免胸腔引流管是安全可行的，可能有利于患者术后快速康复。

新型结直肠灌洗引流管在肠漏合并伤口感染中的应用

目的观察新型结直肠灌洗引流管在肠漏合并伤口感染患者治疗中的使用效果。 方法选择2013年3月－12月术后肠漏合并伤口感染患者7例，采用新型一次性结直肠冲洗引流管进行结直肠持续灌洗，伤口局部采用银敷料抗感染。 结果6例患者采用新型一次性结直肠灌洗引流管进行结直肠持续灌洗治疗后伤口感染及肠漏口愈合，愈合时间为15～82 d，平均36.78 d；1例患者因肠漏口较大，预计短期内难以愈合而行横结肠造瘘术，3个月后行二期手术还纳，伤口愈合时间为21 d。 结论在泌尿手术后肠漏合并伤口感染的处理方法中，使用新型一次性结直肠灌洗引流管进行结直肠灌洗可有效促进肠漏口及伤口愈合，且经济实用，效率高，患者痛苦小，可有效减少护理工作量，提高工作效率。

Different methods to treat injured pleural following off-pump coronary artery bypass grafting using an internal mammary artery: A randomised controlled trial

ObjectiveThe pleural injury caused by harvesting internal mammary artery (LIMA) can significantly increase the possibility of early pleural effusion after off-pump coronary artery bypass grafting (OPCABG). We compared the differences in pleural effusion, pain severity, and early lung function in different treatments to find the optimal strategy.MethodsA total of 300 patients receiving OPCABG using LIMA with left pleural lesion were selected (176 males and 124 females, mean age of 63.1±8.7 years). After bypass surgery, patients with pleural rupture were randomly divided into three groups: group A (n=100) received a pericardial drainage tube and a left chest tube inserted from the midline (subxyphoid); group B (n=100) had a pericardial drainage tube and a tube placed in the sixth intercostal space at the midaxillary line; group C (n=100) with the broken pleura sutured, had a pericardial drainage tube and a mediastinal drainage tube inserted. All patients underwent pulmonary function testing and arterial blood gas analysis on postoperative days (PODs) 5. The three methods were analyzed and evaluated.ResultsTotal drainage: group B (852±285 ml)>group C (811±272 ml)>group A (703±226 ml); there was no significant difference between the group B and group C, but they were statistically different from the group A (P<0 05="" patients="" with="" pleural="" effusion="" after="" removal="" of="" drainage="" tubes:="" group="" a="" 13="" patients="">group B (7 patients)>group C (3 patients), and there was significant difference among the three groups (P<0 05="" pain="" sensation="" the="" day="" after="" extubation:="" group="" b="" 2="" 4="" 0="" 8="" 3="" 8="" 0="" 9="">group A (1.9±0.7, 3.3±0.8)>group C (1.1±0.6, 2.5±0.8), there was significant difference among the three groups (P<0 05="" pain="" sensationon="" on="" postoperative="" days="" 5:="" group="" b="" 0="" 3="" 0="" 2="" 0="" 6="" 0="" 5="">group A (0.3±0.3, 0.5±0.4)>group C (0.2±0.2, 0.5±0.3), and there was no significant difference among the three groups. Vital capacity on postoperative days 5: there was no significant difference between the group B and group C, and both groups were greater than group A (P<0.05). There was no difference in FEV1 and PCO2 among the three groups. Group C was better than group A in PO2 on postoperative day 5 (P<0.05).ConclusionSuturing the broken pleura during the operation can not only reduce the degree of postoperative pain but also have less pleural effusion and better pulmonary function. It can be used as the preferred method.

Application of Two Types of Chest Drainage in Patients after Lung Resection: A Case Controlled Study

ObjectiveTo compare and evaluate the application of two types of chest drainage in patients who had undergone the lung lobe resection. MethodWe retrospective analyzed the clinical data of 240 patients who underwent left lobe resection. The patients were divided into a single conventional drainage group with single chest drainage tube (normal group) and a single conventional drainage tube combined with drainage of disposable surgical negative pressure drainage ball (NPBD) (combination group). There were 140 patients including 86 males and 54 females at mean age of 48.76± 4.92 years in the normal group. There were 100 patients including 58 males and 42 females at mean age of 48.37± 4.56 years in the combination group. We compared the outcomes between the two groups. ResultThe postoperative pathological results revealed there were 12 patients with tuberculosis (TB), 87 patients with squamous carcinoma, and 41 patients with adenocarcinoma in the normal group; 5 patients with TB, 66 patients with squamous carcinoma, and 29 patients with adenocarcinoma in the combination group. There were statistical differences in postoperative hospital stay (11.35± 2.78 d vs. 9.33± 2.46 d), chest drainage tube indwelling time (6.75± 2.10 d vs. 8.28± 2.10 d), total volume of chest drainage (1 176.07± 384.62 ml vs. 926.50± 22.35 ml) with P values less than 0.001 between the normal group and the combination group. No statistical difference was found between the two groups in complications (P>0.05). ConclusionSingle conventional drainage tube combined with drainage of disposable surgical negative pressure drainage ball (NPBD) has more advantages than single conventional chest drainage tube drainage, and is worth to be applied popularly in clinic.

鼻胆引流导管连接引流袋的两种不同方法效果比较

目的探讨鼻胆引流导管连接引流袋的两种方法对临床护理效果的影响。 方法选择2011年1月－8月行内镜下鼻胆管引流患者230例，随机分为试验组与对照组。试验组117例采用手柄组件连接方式，既用无菌剪剪掉伸出过长的鼻胆引流导管部分，保留引流导管距鼻腔长度为40～50 cm，装上手柄组件，连接引流袋的引流导管接头。对照组113例，直接将鼻胆引流导管插入引流袋的输入管中至合适深度，用胶布固定连接处。比较两组引流效果、连接效果、患者舒适度及医护人员工作量的差异。 结果两组在引流量效果方面差异无统计学意义（P＞0.05），但是在引流效果、连接效果、患者舒适度、护理工作量方面，试验组明显优于对照组，差异有统计学意义（P＜0.05）。 结论采用手柄组件连接方法操作简单，连接紧密、不易脱落，可提高患者舒适度，减少污染、避免感染，减少护理工作量，可供临床应用推广。