Application of Improved Indwelling Double Chest Tubes in High-Risk Air Leak Patients Undergoing Single-Port Thoracoscopic Pulmonary Segmentectomy

Backgroun d : For patients with high-risk factors such as pleural adhesions, emphysema, or complex pulmonary segment resection, the use of traditional single chest tube drainage post-operatively can lead to increased pain and delayed recovery. This study aims to explore the application value of the improved dual chest tube indwelling drainage method in reducing pain and improving recovery in such patients. Methods: A prospective randomized controlled trial design was employed, enrolling 90 patients who underwent single-port thoracoscopic pulmonary segmentectomy in the Department of Thoracic Surgery at Tongling People's Hospital, affiliated with Wannan Medical College, from June 2023 to March 2025. Patients were divided into a control group (n=50, conventional 28 Fr chest tube placed through the original incision) and an observation group (n=40, improved dual tube drainage method: one 28 Fr chest tube placed in front of the incision, and a negative pressure drainage ball tube placed behind the incision). The primary endpoint was post-operative pain score (VAS), analyzed using a linear mixed-effects model. Secondary endpoints included drainage time, drainage volume, post-operative hospital stay, and related post-operative complications. Results: The VAS scores demonstrated a significant main effect of time (P<0.001), and there was a significant interaction effect between group and time (P<0.01), indicating that the observation group experienced a faster decrease in post-operative pain. On postoperative day 3 (95% CI=-0.53, P=0.045) and day 5 (95% CI=-1.30, P<0.001), the VAS scores in the observation group were significantly lower than those in the control group. In terms of secondary outcomes, the drainage time in the observation group was significantly shorter than that in the control group (3.26 ± 1.74 days vs. 5.50 ± 2.26 days, P<0.001), with a lower total drainage volume (691.45 ± 365.58 ml vs. 895.53 ± 722.08 ml, P = 0.002) and a shorter postoperative hospital stay (9 [8–11] days vs. 13 [9–16] days, P<0.001). There were no statistically significant differences in surgical time, intraoperative bleeding volume, and complications between the two groups (P>0.05). Conclusion: The improved dual chest tube indwelling drainage method shows potential advantages in reducing postoperative pain and shortening drainage and hospital stay times for high-risk air leak patients following single-port thoracoscopic pulmonary segmentectomy, with no observed trend of increased complications, indicating its feasibility and potential clinical value.