PDF(Pubmed)
Abstract：
Introduction Despite the evidence against drain placement after thyroidectomy, there is a lack of consensus on drain use in patients with substernal goiter. Objective To assess the factors that increase the likelihood of drain placement and its impact on postoperative hematoma and other 30-day complications among adult patients undergoing thyroidectomy for substernal goiter. Methods A retrospective cohort study that used data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Adult patients (aged ≥ 18 years) who underwent elective thyroidectomy for substernal goiter from 2016 to 2020 were included. Cases with closed suction neck drains placed upon completion of surgery were included in the drain group, and the remaining cases formed the nondrain group. Results A total of 1,229 patients were included (46.5% with drain placement). The factors that increased the likelihood of drain placement included body mass index (BMI) ≥ 30 kg/m 2 , score between 3 and 5 on the American Society of Anesthesiologists (ASA) physical status classification, sternal split/transthoracic surgical approach, operative time ≥ 90 minutes, and surgery conducted by otolaryngologists. Patients with clean-contaminated or contaminated wound classifications were less likely to be submitted to drain placement. In addition, drain use had no impact on postoperative hematoma formation but was found to independently increase the risk of prolonged length of hospital stay. Conclusion Thyroidectomy without drain placement might be safe for substernal goiter. However, this decision should be individualized for each patient. Level Of Evidence: 3.
摘要：
引言尽管有证据表明甲状腺切除术后引流管的放置，对于胸骨后甲状腺肿患者使用引流管缺乏共识。目的探讨胸骨后甲状腺肿行甲状腺切除术的成人患者引流管放置的可能性及其对术后血肿和其他30天并发症的影响。方法采用美国外科医师学会国家外科质量改进计划（ACS-NSQIP）的回顾性队列研究。纳入2016年至2020年因胸骨后甲状腺肿行选择性甲状腺切除术的成年患者（年龄≥18岁）。引流组包括手术完成后放置封闭式吸引颈引流的病例。其余病例构成了非排水组。结果共纳入1229例患者(46.5%为引流管)。增加排水管放置可能性的因素包括体重指数（BMI）≥30kg/m2，美国麻醉医师协会（ASA）身体状况分类评分在3到5分之间，胸骨劈开/经胸手术入路，手术时间≥90分钟,和由耳鼻喉科医生进行的手术。具有清洁污染或污染伤口分类的患者不太可能接受引流。此外,引流管的使用对术后血肿形成无影响,但发现可独立增加住院时间延长的风险.结论胸骨后甲状腺肿无引流管的甲状腺切除术可能是安全的。然而,这个决定应该针对每个患者个性化。证据级别：3.
