Batstone Martin Druce, Lowe Derek, Shaw Richard J, Brown James S, Vaughan E David, Rogers Simon N
Maxillofacial Unit, University Hospital Aintree, Lower Lane, Liverpool, L9 7AL, UK.
Eur Arch Otorhinolaryngol. 2009 Jan;266(1):121-4. doi: 10.1007/s00405-008-0723-8. Epub 2008 Jun 12.
Drainage is used following neck dissection to prevent the collection of fluid and aid healing. Active drains are thought to be more effective due to their ability to assist adherence of skin flaps and the minimisation of bacterial migration. There is controversy regarding the type of drain (active or passive) which should be used due to concerns about the potential for compromise of free flap pedicles with active drains. A prospective non-randomised study was undertaken to determine if there were any differences in neck healing following neck dissection between active and passive drains. A consecutive series of patients (the majority of whom had free flap reconstruction) were included over an 8 month period and were examined for delayed healing of the neck wound, flap loss, infection, haematoma and fistula. A total of 60 patients underwent 72 neck dissections during the study period (passive: 13, active: 47). The delayed healing rate in patients with passive drains was 54% compared with 6% for active drains (P < 0.001). This difference remained significant irrespective of surgeon grade, nodal status and whether or not a free flap was performed. There was no patient in whom the drain was thought to contribute to free flap loss. This non-randomised study has shown a significant difference in neck healing depending on the type of drain used following neck dissection. Despite the numerical differences between the groups the patients were relatively well matched for the parameters described. This difference in neck healing, combined with the lack of evidence for a contribution to flap loss, suggests active drains should be used following neck dissection in both free flap and non-free flap cases.
颈部清扫术后进行引流以防止积液并促进愈合。由于主动引流能够帮助皮瓣粘连并减少细菌迁移，因此被认为更有效。对于应使用哪种引流方式（主动或被动）存在争议，因为担心主动引流可能会危及游离皮瓣蒂部。进行了一项前瞻性非随机研究，以确定颈部清扫术后使用主动引流和被动引流在颈部愈合方面是否存在差异。在8个月的时间里纳入了一系列连续的患者（大多数患者进行了游离皮瓣重建），并检查颈部伤口的延迟愈合、皮瓣丢失、感染、血肿和瘘管情况。在研究期间，共有60例患者接受了72次颈部清扫术（被动引流：13例，主动引流：47例）。被动引流患者的延迟愈合率为54%，而主动引流患者为6%（P<0.001）。无论外科医生级别、淋巴结状态以及是否进行了游离皮瓣手术，这种差异均具有统计学意义。没有患者被认为是引流导致了游离皮瓣丢失。这项非随机研究表明，根据颈部清扫术后使用的引流类型，颈部愈合存在显著差异。尽管两组之间在数值上存在差异，但患者在所描述的参数方面相对匹配。颈部愈合的这种差异，再加上没有证据表明引流会导致皮瓣丢失，提示在游离皮瓣和非游离皮瓣病例的颈部清扫术后均应使用主动引流。
