胸腔闭式引流术对原发性自发性气胸破口闭合的影响

目的 探讨不同管径引流管及实施胸腔闭式引流术时机与原发性自发性气胸 （PSP） 患者脏层胸膜破口闭合的关系。方法 实施胸腔闭式引流术的 214 例 PSP 患者中， 所用引流管为标准管和细导管的分别有 136、 78 例；标准管组引流时机≤1 d、 ≤3 d、 ≤6 d、 ＞6 d 的患者分别有 48、 43、 29、 16 例； 细导管组分别有 24、 23、 17、 14 例。测量破口闭合时间， 记录术前为闭合性气胸者在术后转为开放性、 术后出现皮下气肿及疼痛情况。结果 标准管组破口闭合时间（ [ 4.76±1.65） d]与细导管组（ [ 4.54±1.67） d]差异无统计学意义 （t=0.963）。不同引流时机细导管组破口闭合时间与标准管组差异均无统计学意义， 2 组均是引流时机≤6 d 和＞6 d 的破口闭合时间低于≤1 d 和≤3 d 者； 2 组破口闭合时间与引流时机均呈负相关(P＜0.05)。标准管组和细导管组术前为闭合性气胸在术后分别有 51.96% （53/102） 和36.21%(21/58)转为开放性， 不同引流时机 2 组差异均无统计学意义（P＞0.05）， 2 组均是引流时机为≤6 d 和＞6 d 时的比例低于≤1 d 和≤3 d （P＜0.05）。标准管组皮下气肿和疼痛发生率均明显高于细导管组 （P＜0.05）。结论 胸腔闭式引流术治疗 PSP 患者， 不同管径引流管对破口闭合的影响无差异， 延迟实施胸腔闭式引流术有利于破口闭合。

Effect of closed chest drain on wound closure of primary spontaneous pneumothorax

Objective To explore the relationship between visceral pleura closure of primary spontaneous pneumothorax (PSP) using different diameters of drainage tube and the time of implementing closed chest-drain. Methods According to the diameters of tubes for chest drain they used, 214 patients with PSP were divided into standard tube group (136 cases)and fine catheter group (78 cases). Patients in standard tube group who were inserted chest drain for ≤1 d, ≤3 d, ≤6 d, >6 d included 48, 43, 29 and 16 cases respectively while their counterpart in fine catheter group include 24, 23, 17, 14 cases respectively. Closed time of crevasse were noted and incidence of preoperative closed pneumothorax converting into open pneumothorax, subcutaneous emphysema and prolonged pain after operation were all recorded. Results There is no statistical difference in closing time of crevasse nor in the distribution of various drainage times (proportions of ≤ 6 d and > 6 d are lower than proportions of ≤1 d and ≤3 d) between standard tube group [(4.76 ±1.65) d] and fine catheter group [(4.54±1.67) d](t=0.963). However, in both standard tube group and fine catheter group, closing time of crevasse is shorter if drainage time ≤ 6 d or > 6 d than if it ≤ 1 d and ≤3 d. Closing time of crevasse show negative correlation with period of chest drain insertion in both standard tube group and fine catheter group (P < 0.05). The rate of converting from close pneumothorax into open pneumothorax were 51.96% (53/102) and 36.21% (21/58) respectively in standard pipe group and fine catheter group.Furthermore, the incidence of subcutaneous emphysema and prolonged pain were all higher than those in standard tube group than those in the fine catheter group (P < 0.05). Conclusion Using closed chest drain to treat patients with PSP, diameter of the drain tube did not affect closing time of crevasse. But longer insertion period of chest drain can reduce closing time of crevasse.