Department of Otolaryngology, Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, NR4 7UY, UK.
Department of Otolarygology, Ipswich Hospital, East Suffolk and North Essex NHS Foundation Trust, Heath Road, Ipswich, IP4 5PD, UK.
Eur Arch Otorhinolaryngol. 2019 Jul;276(7):2025-2029. doi: 10.1007/s00405-019-05449-x. Epub 2019 May 28.
Parotidectomy is the definitive procedure for diagnosis and treatment of most parotid masses but, due to the risk of haematoma and seroma formation, has traditionally included a drain. The drain itself comes with its own risks and, in most hospitals, the need for overnight admission, which has significant cost implications (Mallon et al. Ann R Coll Surg Engl 95(4):258-262; 2013). Fibrin glue, with its haemostatic and adhesive properties, reduces the risk of collection or haematoma and therefore may negate the need for a drain. This is the first study to look at the use of ARTISS as an alternative to drains in parotidectomy.
We performed a retrospective study of all the patients who underwent a partial parotidectomy over a 4-year period from 2014 until 2018 under the same senior surgeon. Patients were divided into those that had a drain and those that had ARTISS. Their operative record, inpatient notes and clinic letters were reviewed to record information regarding length of stay, histology, complications and recurrence.
A total of 34 patients were identified; 17 ARTISS and 17 drain patients. We showed that the mean length of stay improved significantly from 1.6 days with the drain to 0.5 days with ARTISS (Fig. 1) but without a difference in complication rate (Fig. 2), which was 5/17 (29%) in each group.
In conclusion, parotidectomy can be undertaken safely as a day-case procedure with the application of ARTISS. This new approach to parotid surgery not only offers less morbidity for patients but also positive financial revenue for public health institutions.
腮腺切除术是诊断和治疗大多数腮腺肿块的确定性手术，但由于血肿和血清肿形成的风险，传统上包括引流管。引流管本身存在风险，而且在大多数医院，需要住院过夜，这会带来重大的成本影响（Mallon 等人，《安大略外科学院学报》95（4）：258-262；2013 年）。纤维蛋白胶具有止血和黏附特性，可以降低积聚或血肿的风险，因此可能不需要引流管。这是第一项研究，旨在探讨 ARTISS 在腮腺切除术中替代引流管的作用。
我们对 2014 年至 2018 年期间由同一位资深外科医生进行的所有腮腺部分切除术患者进行了回顾性研究。患者分为使用引流管和使用 ARTISS 的两组。他们的手术记录、住院记录和门诊信件被审查，以记录住院时间、组织学、并发症和复发等信息。
共确定了 34 名患者；17 名使用 ARTISS，17 名使用引流管。我们表明，与使用引流管的患者（1.6 天）相比，使用 ARTISS 的患者的平均住院时间显著缩短至 0.5 天（图 1），但并发症发生率没有差异（图 2），两组的并发症发生率均为 5/17（29%）。
总之，使用 ARTISS 可以安全地将腮腺切除术作为日间手术进行。这种新的腮腺手术方法不仅为患者提供了更低的发病率，而且为公立医疗机构带来了积极的经济效益。
