探讨单孔胸腔镜辅助手术(VATS)后不留置胸管在胸外科手术中应用的可行性和安全性。

收集2015年1月—2017年5月期间在中南大学湘雅医院胸外科行单孔VATS患者的临床资料，根据是否留置胸管分为无胸管留置组和胸管留置组，根据病种不同将无胸管留置组患者再分为手汗症组与非手汗症组，分别比较两组患者的性别构成、平均年龄以及术后并发症发生率、疼痛评分、住院时间等指标。

共59例患者纳入研究，其中单孔VATS无胸管留置患者44例，胸管留置患者15例。非手汗症无胸管留置组患者的术后疼痛评分明显低于留置胸管组，差异有统计学意义[(3.6±0.8)分vs (4.7±1.3)分，P＝0.021]；但两组间住院时间和术后并发症发生率比较，差异均无统计学意义(P>0.05)。无胸管留置患者中，手汗症组术后住院时间显著短于非手汗症组，差异有统计学意义[(1.7±0.9)d vs (3.9±1.1)d，P<0.001]；疼痛评分和并发症发生率均显著低于非手汗症组，差异也均有统计学意义[(2.2±0.7)分vs (3.6±0.8)分，P<0.001；9.4% vs 58.3%，P＝0.002)]。

单孔VATS胸部手术后不留置胸腔引流管，对选择性的部分患者来说是可行和安全的。

To investigate the clinical feasibility and safety of single-port VATS without chest tube in fast track thoracic surgery.

The clinical data of patients with single-port VATS in thoracic surgery in Xiangya Hospital between January 2015 and May 2017 were retrospectively analyzed. Patients were divided into different groups according to chest tube placement and diseases respectively. The gender, age, postoperative complications, pain score and hospitalization time were statistically analyzed.

A total of 59 patients were included in this research, including 44 patients with single-port VATS without chest tube and 15 patients with single-port VATS with chest tube. Compared to non hyperhidrosis patients with chest tube, there were significant differences in pain score [(3.6±0.79) scores vs (4.7±1.34) scores, P=0.021] in patients without chest tube, and no significant differences in hospitalization time and postoperative complications (P>0.05). In single-port VATS without chest tube group, compared to non palmar hyperhidrosis patients, there were significant differences in the hospitalization time [(1.7±0.9) d vs (3.9±1.1) d, P<0.001], pain score [(2.2±0.7) scores vs (3.6±0.8) scores, P<0.001] and complications (9.4% vs 58.3%, P=0.002) in palmar hyperhidrosis patients.

VATS in thoracic surgery without chest tube, if criterions for the surgery are strictly followed, is feasible and security in carefully selected patients.