胸腔镜辅助肺楔形切除术后无胸腔引流管的安全性和影响

Safety and Effect on Enhanced Recovery of a No Chest Drain Strategy Following VATS Wedge Resection: A Propensity-Matched Cohort Study
胸腔镜辅助肺楔形切除术后无胸腔引流管的安全性和影响
Objective:Conventional chest tube placement after VATS wedge resection increases patient discomfort and hospitalization. This large-scale, propensity-matched study aimed to compare the safety and efficacy of the no chest drain strategy against the conventional chest drain (CD) approach.
Methods: We conducted a retrospective cohort study of patients undergoing VATS wedge resection between January and August 2024. Propensity score matching (PSM) was performed based on sex, age, smoking history, and lesion size, among other relevant clinical factors, to balance baseline characteristics between the no chest drain (NCD) and chest drain (CD) groups. The primary outcomes were the radiographic abnormality rate and the reoperation rate.
Results:After propensity score matching, 268 well-balanced patient pairs were included (all baseline characteristics, p > 0.05). Analysis of primary outcomes revealed no significant difference in the reoperation rate (1.1% vs. 0.4%, p=0.315). However, the chest tube (CT) group demonstrated a significantly higher overall rate of radiographic abnormalities compared to the no chest tube (NCT) group (75.4% vs. 62.7%, p=0.001). This difference was primarily driven by an increase in the incidence of subcutaneous emphysema, whereas the rates of pneumothorax and pleural effusion were comparable between the two groups. Furthermore, the NCT group had a significantly shorter postoperative hospital stay (p<0.001), with no difference in postoperative pain scores between the groups.


Conclusion: This large-scale propensity score-matched analysis demonstrates that the NCD strategy for VATS wedge resection provides comparable safety to conventional chest tube placement regarding the need for reoperations, while significantly reducing postoperative hospitalization. The higher incidence of radiographic abnormalities in the chest tube group predominantly represented minor complications not requiring clinical management. These findings support the integration of NCD strategy into enhanced recovery protocols for appropriately selected patients undergoing wedge resection.

Yucong Deng (1), Keyao Dai (1), Jiekai Liang (1), Miao He (1), Shen Lao (1), Wei Wang (1), (1) the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China