Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
Study Centre of the German Surgical Society, University of Heidelberg, Heidelberg, Germany.
Br J Surg. 2018 Nov;105(12):1573-1582. doi: 10.1002/bjs.10975. Epub 2018 Sep 10.
The objective of this study was to investigate the potential benefit of local haemostatic agents for the prevention of postoperative bleeding after thyroidectomy.
A systematic literature search was performed, and RCTs involving adult patients who underwent thyroid surgery using either active (AHA) or passive (PHA) haemostatic agents were included in the review. The main outcome was the rate of cervical haematoma that required reoperation. A Bayesian random-effects model was used for network meta-analysis with minimally informative prior distributions.
Thirteen RCTs were included. The rate of cervical haematoma requiring reoperation ranged from 0 to 9·1 per cent, and was not reduced by haemostatic agents: AHA versus control (odds ratio (OR) 1·53, 95 per cent credibility interval 0·21 to 10·77); PHA versus control (OR 2·74, 0·41 to 16·62) and AHA versus PHA (OR 1·77, 0·12 to 25·06). No difference was observed in the time required for drain removal, duration of hospital stay, and the rate of postoperative hypocalcaemia or recurrent nerve palsy. AHA led to a significantly lower total postoperative blood loss and reduced operating time in comparison with both the control and PHA groups.
The general use of local haemostatic agents has not been shown to reduce the rate of clinically relevant bleeding.
本研究旨在探讨局部止血剂在预防甲状腺手术后出血方面的潜在益处。
系统检索文献，并纳入了使用活性（AHA）或被动（PHA）止血剂行甲状腺手术的成年患者的 RCT。主要结局是需要再次手术的颈部血肿发生率。采用贝叶斯随机效应模型进行网络荟萃分析，并采用最小信息先验分布。
共纳入 13 项 RCT。需要再次手术的颈部血肿发生率为 0 至 9.1%，止血剂并不能降低其发生率：AHA 与对照组（比值比 (OR) 1.53，95%可信区间 0.21 至 10.77）；PHA 与对照组（OR 2.74，0.41 至 16.62）和 AHA 与 PHA（OR 1.77，0.12 至 25.06）。引流管拔除时间、住院时间、术后低钙血症或喉返神经麻痹发生率无差异。与对照组和 PHA 组相比，AHA 可显著减少总术后出血量和手术时间。
一般来说，局部止血剂的使用并未显示可降低临床相关出血的发生率。
