背景:卵巢癌(OC)占妇科恶性肿瘤的近4%,通常在晚期诊断。膈肌手术,晚期卵巢癌(ASOC)减瘤手术的基本步骤,与高术后并发症发生率相关,这被认为是减少与胸廓造口管放置。我们评估了术中胸腔造口术置管的作用,作为术后并发症的预防措施,膈肌切除术后。
方法:这是一项单中心前瞻性随机试验。卵巢癌患者,接受单外侧膈切除术的人,以1:1随机分为两组。A组包括接受术中胸腔造口管置入(TP)的患者;B组患者未接受胸腔造口管置入(NTP)。手术后,所有患者均接受了连续的胸部X线和超声检查,以记录胸部并发症.统计分析包括单变量和多变量逻辑回归模型(比例几率模型)。
结果:筛选了三百七十一例患者,纳入了88例患者:A和B组44例,分别。术中(p=0.291)和术后并发症的任何等级(p=0.072)均无统计学差异,而A组6.8%的患者和B组22.7%的患者出现严重的呼吸道症状(p=0.035);A组18.2%的患者出现中度/大量胸腔积液,B组65.9%(p<0.0001)。在多变量分析中,结果证实,与TP组相比,NTP组因胸腔积液而接受术后胸腔置管的风险更高(比值比[95%置信区间]=14.5[3.7-57.4]).
结论:膈肌切除术后胸腔造口术中置管可有效预防术后胸腔并发症。切除范围的延长不会影响结果,术后胸腔穿刺术或TP的风险仍然升高。
BACKGROUND: Ovarian cancer (OC) represent nearly 4% of gynecologic malignancies and it is often diagnosed at advanced stage. Diaphragmatic surgery, a fundamental step of advanced stage ovarian cancer (ASOC) debulking surgery, is associated with a high post-operative complication incidence, which is supposedly reduced with thoracostomy tube placement. We assessed the role of intra-operative thoracostomy tube placement, as a prevention measure for post-operative complications, after diaphragmatic resection.
METHODS: This was a single center prospective randomized
trial. Ovarian cancer patients, who underwent mono-lateral diaphragmatic resection, were randomized 1:1 into two arms. Arm A included patients receiving intra-operative thoracostomy tube placement (TP); Arm B patients did not receive thoracostomy tube placement (NTP). After surgery, all patients underwent seriate chest x-ray and ultrasound to record thoracic complications. Statistical analysis included uni- and multivariable logistic regression model (proportional odds model).
RESULTS: Three hundred seventy-one patients were screened and 88 patients were enrolled: 44 in arm A and B, respectively. No statistically significant differences for intra-operative (p = 0.291) and any grade of post-operative complication (p = 0.072) were detected, while 6.8% of patients in arm A and 22.7% in arm B experienced severe respiratory symptoms (p = 0.035); 18.2% of patients in arm A had a moderate/large pleural effusion versus 65.9% in arm B (p < 0.0001). At multivariable analysis, results confirmed that the NTP-group had a higher risk to receive post-operative thoracostomy tube placement due to pleural effusion than the TP-group (odds ratio [95% Confidence Interval] = 14.5 [3.7-57.4]).
CONCLUSIONS: Thoracostomy intra-operative tube placement after diaphragmatic resection is effective to prevent post-operative thoracic complications. The extension of resection does not influence outcomes and the risk of post-operative thoracentesis or TP remain elevated.