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OA

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.