背景:使用宫颈引流来预防甲状腺切除术后的宫颈血肿或血清瘤仍然是一个有争议的问题。
目的:确定血肿或血清瘤的临床和手术危险因素,并评估甲状腺手术后常规使用引流管的有效性。
方法:作者进行了一项回顾性多中心研究,涉及2018年1月至2020年12月在7家葡萄牙医院接受甲状腺手术的连续患者(n=945)。收集的数据包括以下参数:患者的年龄和性别,抗凝或抗聚集治疗,组织学诊断,手术类型,是否存在术后引流,甲状腺重量,住院时间,术后并发症,和重新干预。在这项研究中,评估的手术并发症仅限于血肿或血清瘤的存在。共有945例接受甲状腺手术的患者被纳入研究。27名患者(2.9%,n=27)经历了分为血肿或血清瘤的并发症。在该系列中,根据低凝状态或抗聚集状态(OR=3.62;95%CI1.14-11.4)(p=0.001)和组织学诊断的性质(毒性与无毒良性疾病)(OR=6.59;95%CI1.83-23.7)。低凝状态或抗聚集状态与更高的并发症风险独立相关。引流管的存在与住院时间延长有关(p<0.001),而对再干预的需求并未减少。
结论:宫颈血肿或血清肿是与低凝和抗聚集治疗以及良性毒性病理相关的罕见并发症。使用排水沟并不会减少再次干预的需要,甚至与更长的住院时间有关;因此,他们的日常使用不应该被建议。
BACKGROUND: The use of cervical drains to prevent cervical hematoma or seroma after thyroidectomy remains a controversial issue.
OBJECTIVE: Identify clinical and surgical risk factors for hematoma or seroma and evaluate the usefulness of routine use of drains following thyroid surgery.
METHODS: The authors conducted a retrospective multicentric study related to consecutive patients submitted to thyroid surgery in seven Portuguese hospitals between January 2018 and December 2020 (n=945). The data collected included the following parameters: age and gender of the patients, anticoagulation or anti-aggregating therapy, histological diagnoses, type of surgery, the presence or absence of postoperative drains, thyroid weight, length of hospital stay, postoperative complications, and reinterventions. In this study, surgical complications evaluated were limited to the presence of hematoma or seroma. A total of 945 patients who underwent thyroid surgery were included in the study. Twenty-seven patients (2.9%, n=27) experienced complications classified as hematomas or seromas. In the series, significant differences were observed between the two groups according to hypocoagulation or anti-aggregation status (OR=3.62; 95% CI 1.14-11.4) (p=0.001) and the nature of histological diagnosis (toxic vs. non-toxic benign disease) (OR=6.59; 95% CI 1.83-23.7). Hypocoagulation or anti-aggregation status were independently associated with a higher risk of complications. The presence of drains was associated with longer hospitalization periods (p<0.001) and not a decreased need for reintervention.
CONCLUSIONS: Cervical hematoma or seroma are rare complications associated with both hypocoagulation and anti-aggregation therapy and with the presence of benign toxic pathology. The use of drains does not decrease the need for reintervention and is even associated with a longer length of hospital stay; therefore, their routine use should not be advised.