中国肺癌杂志2026，Vol.29Issue(2)：105-114,10.DOI:10.3779/j.issn.1009-3419.2026.102.04
基于倾向性评分匹配的单孔胸腔镜肺楔形切除术后免引流管策略安全性与临床获益分析
Safety and Clinical Benefit Analysis of No-chest-tube Strategy After Uniportal Video-assisted Thoracoscopic Pulmonary Wedge Resection Based on Propensity Score Matching
摘要
Abstract
Background and objective With the wide application of uniportal video-assisted thoracoscopy in the diagnosis and treatment of small pulmonary nodules,the optimization of postoperative chest tube management has become a focus of enhanced recovery after thoracic surgery.This study aimed to investigate the safety and non-inferiority of a no-drain strategy following uniportal video-assisted thoracoscopic wedge resection.Methods A total of 203 eligible patients who underwent surgery between January 2023 and May 2025 were enrolled and allocated to the no-drain group(n=53)and the drain group(n=150).After propensity score matching(PSM),41 well-balanced pairs were generated.Non-inferiority testing combined with Bayesian analysis was performed to assess postoperative outcomes.Results After PSM,the no-drain group met the predefined non-inferiority criteria for the incidence of postoperative fever(19.51%vs 26.83%),pleural effusion(24.39%vs 21.95%),and the proportion of patients requiring additional analgesics(12.20%vs 9.76%),with the upper bound of the 95%CI for between-group differences not exceeding the 10%non-inferiority margin.The no-drain group demonstrated a sig-nificantly shorter median postoperative length of stay(2.00 vs 3.00 d,P<0.001)and lower visual analogue scale(VAS)scores on postoperative day 1(P=0.0495),with non-inferiority confirmed.However,non-inferiority was not established for second-ary intervention rates(primarily chest tube reinsertion,4.88%vs 0.00%)or radiologic complications(73.17%vs 65.85%),as the upper limit of the 95%CI for the between-group differences exceeded the 10%margin.Bayesian analysis showed that the probability that the positive rate of imaging-related complications in the no-drain group was higher than that in the drain group was 77.18%,and the probability that the absolute value of the difference in positive rates between the two groups greater than 10.0%was 44.45%.Conclusion In carefully selected low-risk patients,a no-drain strategy following uniportal thoracoscopic wedge resection may reduce postoperative pain and shorten hospital stay,while meeting non-inferiority criteria for key safety outcomes.However,non-inferiority was not demonstrated for secondary chest tube insertion or radiologic complications.En-hanced postoperative monitoring is therefore essential to ensure clinical safety.关键词
肺肿瘤/单孔胸腔镜/肺楔形切除术/胸腔闭式引流管/倾向性评分匹配/非劣效性研究/贝叶斯分析Key words
Lung neoplasms/Uniportal thoracoscopy/Wedge resection/Chest tube/Propensity score matching/Non-inferiority study/Bayesian analysis引用本文复制引用
林楚童,宁英泽,马善吴,汤继征,金亮,贺未,何华钰,强光亮..基于倾向性评分匹配的单孔胸腔镜肺楔形切除术后免引流管策略安全性与临床获益分析[J].中国肺癌杂志,2026,29(2):105-114,10.基金项目
本研究受北京市自然科学基金重点研究专项(No.24Z10018)和北京大学第三医院院临床重点项目(No.BYSYRCYJ2023001,No.BYSYZD2025049)资助 This study was supported by the grants from the Beijing Natural Science Foundation(No.24Z10018,to Guangliang QIANG),and the Clinical Key Project of Peking University Third Hospital(No.BYSYRCYJ2023001,to Guangliang QIANG （No.24Z10018）
No.BYSYZD2025049,to Chutong LIN). （）
