Service de chirurgie générale, viscérale et endocrinienne, hôpital de la Pitié-Salpêtrière, université Paris 6, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
J Visc Surg. 2013 Jun;150(3):165-71. doi: 10.1016/j.jviscsurg.2013.04.002. Epub 2013 Jun 3.
Cervical hematoma with airway compromise is a severe complication that may be rapidly lethal or result in irreversible cerebral anoxia if the hematoma is not urgently decompressed. It is therefore indispensable to know the essential relevant elements as well as predictive criteria for this complication before envisioning ambulatory thyroidectomy.
The Association francophone de chirurgie endocrinienne (AFCE) sought to answer several questions raised by the proposal of ambulatory thyroidectomy and to propose recommendations based on a review of the literature, an inquiry sent out to members of the AFCE, and an in-depth research of the medicolegal risks involved, based essentially on jurisprudence. The details scrutinized included preoperative selection criteria, the characteristics of the operation and the basic elements of postoperative surveillance.
The standard today is at least an overnight hospital stay. In fact, hospital stay can be less than 24h because the risk of cervical compressive hematoma is very unusual beyond this interval. Ambulatory (outpatient) thyroidectomy (0 nights) is possible under certain conditions for highly selected patients according to criteria described in the literature that also define relative contra-indications. In case of life-threatening or functional complications, the surgeon stands first in the line of responsibility. The surgeon must therefore ensure that the patient and family were fully informed of the contra-indications, the normal course of postoperative events, of pertinent elements of postoperative surveillance and of the conditions under which the patient can be safely discharged. The surgeon must also realize that this type of management is time-consuming.
颈椎血肿伴气道阻塞是一种严重的并发症，如果血肿不紧急减压，可能会迅速致命或导致不可逆转的脑缺氧。因此，在考虑门诊甲状腺切除术之前，了解这种并发症的基本相关因素和预测标准是必不可少的。
法语内分泌外科学会（AFCE）试图回答门诊甲状腺切除术建议中提出的几个问题，并根据文献复习、向 AFCE 成员发出的调查以及对涉及的医疗法律风险的深入研究，提出建议，主要基于判例法。审查的细节包括术前选择标准、手术特点和术后监测的基本要素。
目前的标准至少是住院过夜。事实上，住院时间可以少于 24 小时，因为在此时间后发生颈椎压迫性血肿的风险非常罕见。根据文献中描述的标准，为高度选择的患者，在某些条件下可以进行门诊（日间）甲状腺切除术（0 个晚上）。在危及生命或功能的并发症的情况下，外科医生首先承担责任。因此，外科医生必须确保患者及其家属充分了解禁忌症、术后正常事件过程、术后监测的相关要素以及患者可以安全出院的条件。外科医生还必须意识到这种管理方式很耗时。
