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.
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。