Department of Academic Surgery, Cork University Hospital, University College Cork, Cork, Ireland.
World J Surg Oncol. 2012 Apr 28;10:72. doi: 10.1186/1477-7819-10-72.
Thyroid drains following thyroid surgery are routinely used despite minimal supportive evidence. Our aim in this study is to determine the impact of routine open drainage of the thyroid bed postoperatively on ultrasound-determined fluid accumulation at 24 hours.
We conducted a prospective randomised clinical trial on patients undergoing thyroid surgery. Patients were randomly assigned to a drain group (n = 49) or a no-drain group (n = 44) immediately prior to wound closure. Patients underwent a neck ultrasound on day 1 and day 2 postoperatively. After surgery, we evaluated visual analogue scale pain scores, postoperative analgesic requirements, self-reported scar satisfaction at 6 weeks and complications.
There was significantly less mean fluid accumulated in the drain group on both day 1, 16.4 versus 25.1 ml (P-value = 0.005), and day 2, 18.4 versus 25.7 ml (P-value = 0.026), following surgery. We found no significant differences between the groups with regard to length of stay, scar satisfaction, visual analogue scale pain score and analgesic requirements. There were four versus one wound infections in the drain versus no-drain groups. This finding was not statistically significant (P = 0.154). No life-threatening bleeds occurred in either group.
Fluid accumulation after thyroid surgery was significantly lessened by drainage. However, this study did not show any clinical benefit associated with this finding in the nonemergent setting. Drains themselves showed a trend indicating that they may augment infection rates. The results of this study suggest that the frequency of acute life-threatening bleeds remains extremely low following abandoning drains. We advocate abandoning routine use of thyroid drains.
ISRCTN94715414.
尽管缺乏支持性证据，但甲状腺手术后常规使用引流管。我们的研究旨在确定术后常规开放甲状腺床引流对 24 小时超声确定的液体积聚的影响。
我们对接受甲状腺手术的患者进行了前瞻性随机临床试验。在关闭伤口前，患者被随机分配到引流组（n=49）或无引流组（n=44）。患者在术后第 1 天和第 2 天进行颈部超声检查。手术后，我们评估了视觉模拟评分疼痛、术后镇痛需求、术后 6 周的自我报告疤痕满意度和并发症。
术后第 1 天和第 2 天，引流组的平均液体积聚量明显较少，分别为 16.4ml 和 18.4ml（P 值分别为 0.005 和 0.026）。两组在住院时间、疤痕满意度、视觉模拟评分和镇痛需求方面均无显著差异。引流组有 4 例和无引流组有 1 例伤口感染，差异无统计学意义（P=0.154）。两组均未发生危及生命的出血。
引流可显著减少甲状腺手术后的液体积聚。然而，这项研究在非紧急情况下并没有发现与这一发现相关的任何临床益处。引流本身显示出一种趋势，表明它们可能会增加感染率。这项研究的结果表明，放弃引流后，急性危及生命的出血的发生率仍然极低。我们主张放弃常规使用甲状腺引流管。
ISRCTN94715414。
