PDF(Pubmed)
Abstract：
Postoperative compressive neck hematoma occurs in approximately 0.1% to 1.7% of cases, most occurring within the first six hours after surgery. Thyroid pathology, patient predisposition, and surgical technique are major risk factors for postoperative hematoma. This narrative review describes current perspectives on predicting and preventing bleeding following thyroid surgery. Predictors of bleeding after thyroid surgery include patient-related factors such as male sex and age, surgery-related factors like total thyroidectomy and operations for thyroid malignancy, and surgeon-related factors. Hemostasis is the primary focus after preserving critical structures in thyroid surgery. The clamp-and-tie technique has been the standard method for dividing the thyroid gland\'s main vascular pedicles for many years. Bipolar electrocautery has been used for vessels of small size. However, advanced bipolar and ultrasound energy and hybrid devices are now available options that may reduce operative time without increasing costs or complications. In cases where small bleeders close to critical structures are present and the clamp-and-tie technique is not feasible, hemostatic agents are commonly used. Drains do not appear to provide any significant benefits in preventing the sequelae of bleeding after thyroid surgery.
摘要：
术后颈部压缩性血肿发生在约0.1%至1.7%的病例中，大多数发生在手术后的前六小时内。甲状腺病理,患者倾向,手术技术是术后血肿的主要危险因素。这篇叙述性综述描述了预测和预防甲状腺手术后出血的最新观点。甲状腺手术后出血的预测因素包括患者相关因素，如男性和年龄，手术相关因素，如甲状腺全切除术和甲状腺恶性肿瘤手术，和外科医生相关因素。在甲状腺手术中保留关键结构后，止血是主要重点。多年来，钳夹技术一直是划分甲状腺主要血管蒂的标准方法。双极电灼已用于小尺寸的血管。然而,先进的双极和超声能量和混合设备现在是可用的选项，可以减少手术时间，而不会增加成本或并发症。如果存在靠近关键结构的小泄放器，并且夹紧扎带技术不可行，止血剂是常用的。引流似乎在预防甲状腺手术后出血后遗症方面没有任何明显的益处。
