PDF(Pubmed)
Abstract：
OBJECTIVE: Using liquid fibrin sealants has once again questioned the benefit of drain placement in head and neck operations. Cellulose-based hemostats offering different hemostasis mechanisms have scarcely been investigated in drainless neck surgeries. This study aimed to evaluate whether liquid fibrin sealant offers any advantage over cellulose-based hemostats in various head and neck surgeries.
METHODS: A prospective trial of patients who underwent various neck surgeries between 2020 and 2022. Baseline characteristics and postoperative outcomes were compared between the drain-placed and the drainless groups, with the latter sub-categorized into three groups: fibrin sealant, cellulose-based hemostats, and a combination of both.
RESULTS: A total of 119 patients were included (63 thyroidectomies, 40 parathyroidectomies, and 16 sialoadenectomies). Fifty eight had a drain placed and 61 had no drain. In the drainless group, 23 patients received cellulose-based absorbable hemostats (SURGICEL®/ FIBRILLAR™); 18 patients had fibrin sealants (EVICEL®/TachoSil®/TISSEEL); in 16, a combination of both was used; and in four patients, no hemostatic agent was used. Three (5%) of the 61 drainless patients developed a seroma compared to one (2%) seroma in the drain-placed patients. No advantage was demonstrated using a combination of FIBRILLAR™ with a fibrin sealant nor for any used separately. Drain placement delayed patient discharge by at least one day compared to the group without a drain (p < 0.001).
CONCLUSIONS: Drain placement offered a minor advantage in the postoperative course reducing rates of seroma formation, while delaying patient discharge by at least one day. There was no advantage in using a specific hemostatic agent over the other.
METHODS: A prospective trial of patients who underwent various neck surgeries between 2020 and 2022. Baseline characteristics and postoperative outcomes were compared between the drain-placed and the drainless groups, with the latter sub-categorized into three groups: fibrin sealant, cellulose-based hemostats, and a combination of both.
RESULTS: A total of 119 patients were included (63 thyroidectomies, 40 parathyroidectomies, and 16 sialoadenectomies). Fifty eight had a drain placed and 61 had no drain. In the drainless group, 23 patients received cellulose-based absorbable hemostats (SURGICEL®/ FIBRILLAR™); 18 patients had fibrin sealants (EVICEL®/TachoSil®/TISSEEL); in 16, a combination of both was used; and in four patients, no hemostatic agent was used. Three (5%) of the 61 drainless patients developed a seroma compared to one (2%) seroma in the drain-placed patients. No advantage was demonstrated using a combination of FIBRILLAR™ with a fibrin sealant nor for any used separately. Drain placement delayed patient discharge by at least one day compared to the group without a drain (p < 0.001).
CONCLUSIONS: Drain placement offered a minor advantage in the postoperative course reducing rates of seroma formation, while delaying patient discharge by at least one day. There was no advantage in using a specific hemostatic agent over the other.
摘要：
目的：使用液体纤维蛋白封闭剂再次质疑引流在头颈部手术中的益处。在无引流颈部手术中，几乎没有研究提供不同止血机制的基于纤维素的止血剂。这项研究旨在评估液体纤维蛋白密封剂在各种头颈部手术中是否比纤维素基止血剂具有任何优势。
方法：一项对2020年至2022年接受各种颈部手术的患者进行的前瞻性试验。比较放置引流管和无引流管的基线特征和术后结果，后者分为三组：纤维蛋白密封剂，基于纤维素的止血剂，以及两者的结合。
结果：共纳入119例患者（63例甲状腺切除术，40例甲状旁腺切除术,和16例唾液腺切除术）。58个有排水沟，61个没有排水沟。在无排水组中，23例患者接受了基于纤维素的可吸收止血剂（SURGICEL®/FIBRILLAR™）；18例患者使用了纤维蛋白封闭剂（EVICEL®/TachoSil®/TISSEEL）；16例患者使用了两者的组合；4例患者，未使用止血剂。61例无引流患者中有3例（5％）出现血清肿，而引流患者中有1例（2％）出现血清肿。使用FIBRILLAR™与纤维蛋白密封剂的组合以及任何单独使用都没有显示出优势。与没有引流的组相比，引流放置延迟了患者出院至少一天（p<0.001）。
结论：引流在降低血清肿形成率的术后病程中具有较小的优势，同时延迟患者出院至少一天。使用特定的止血剂与其他止血剂相比没有优势。
方法：一项对2020年至2022年接受各种颈部手术的患者进行的前瞻性试验。比较放置引流管和无引流管的基线特征和术后结果，后者分为三组：纤维蛋白密封剂，基于纤维素的止血剂，以及两者的结合。
结果：共纳入119例患者（63例甲状腺切除术，40例甲状旁腺切除术,和16例唾液腺切除术）。58个有排水沟，61个没有排水沟。在无排水组中，23例患者接受了基于纤维素的可吸收止血剂（SURGICEL®/FIBRILLAR™）；18例患者使用了纤维蛋白封闭剂（EVICEL®/TachoSil®/TISSEEL）；16例患者使用了两者的组合；4例患者，未使用止血剂。61例无引流患者中有3例（5％）出现血清肿，而引流患者中有1例（2％）出现血清肿。使用FIBRILLAR™与纤维蛋白密封剂的组合以及任何单独使用都没有显示出优势。与没有引流的组相比，引流放置延迟了患者出院至少一天（p<0.001）。
结论：引流在降低血清肿形成率的术后病程中具有较小的优势，同时延迟患者出院至少一天。使用特定的止血剂与其他止血剂相比没有优势。
