Department of Oncology Plastic Surgery/Head and Neck Surgery, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya Medical School, Central South University, Changsha, 410008, Hunan, China.
Surg Endosc. 2021 Jan;35(1):358-366. doi: 10.1007/s00464-020-07408-8. Epub 2020 Feb 7.
To find the optimal size of a drain for the reliable drainage and the best cosmetic result in TOETVA. To explore the normal drainage flow rate after TOETVA.
A prospective randomized controlled trial was performed in a single center from December 2016 to December 2018. One hundred and fifty-three (153) patients had TOETVA with a single incision and were randomly divided into two groups. Self-made drainage tubes with a small diameter (outer diameter 2.0 mm, inner diameter 1.0 mm) were used in 80 patients (experimental group). No. 8 tubes were used in 73 patients (control group). The clinical characteristics and results between both groups were compared by t test or chi-square test, and the results of normal drainage flow rate were calculated.
The experimental group had a longer intraoperative tube-inserting time, compared with the control group (9.5 ± 2.5 min vs. 5.6 ± 1.4 min, p = 0.001), a smaller scar six months after the operation (1.8 ± 2.3 mm vs. 3.1 ± 2.6 mm, p = 0.002), and a lower Vancouver Scar Scale score at both one month (3.20 ± 1.44 vs. 4.19 ± 1.92, p = 0.001) and six months after the operation(1.43 ± 1.84 vs. 2.40 ± 2.37, p = 0.006). The drainage volume, pain score on the first day, postoperative complications (tube blockage, air leakage, subcutaneous hydrops, hematoma, regional infection), and the extubation time were not significantly different. The average drainage of 148 patients without postoperative complications was 78.3 ± 10.9 ml. The cumulative drainage within 8 h, and 32 h after the operation accounted for 53.2% and 91.9% of the total drainage, respectively. The residual drainage at 32 h was estimated to be 6.5 ± 2.9 ml (P95 = 11.0 ml). A linear regression equation between total volume (V) and the size of resected tissue (S) was established: V = 1.625 S + 56.604 (p = 0.0001).
In TOETVA, a small drain can provide a good cosmetic appearance and reliable drainage. The main exudation period of the wound is within 8 h after the operation. If a residual volume of less than 11 ml is considered to be self-absorbable, the shortest safe extubation point for 95% of patients should be 32 h after the operation.
在 TOETVA 中找到最佳的引流管大小，以确保可靠的引流和最佳的美容效果。探索 TOETVA 后的正常引流流速。
这是一项在 2016 年 12 月至 2018 年 12 月期间在一家单中心进行的前瞻性随机对照试验。153 名（153）患者接受了单次切口的 TOETVA，并随机分为两组。80 名患者（实验组）使用自制的小直径引流管（外径 2.0mm，内径 1.0mm）。73 名患者（对照组）使用 No.8 引流管。通过 t 检验或卡方检验比较两组的临床特征和结果，并计算正常引流流速的结果。
实验组的术中置管时间明显长于对照组（9.5±2.5 分钟 vs. 5.6±1.4 分钟，p=0.001），术后 6 个月的疤痕更小（1.8±2.3 毫米 vs. 3.1±2.6 毫米，p=0.002），术后 1 个月（3.20±1.44 分 vs. 4.19±1.92 分，p=0.001）和 6 个月（1.43±1.84 分 vs. 2.40±2.37 分，p=0.006）的温哥华疤痕量表评分也较低。引流量、术后第一天疼痛评分、术后并发症（引流管堵塞、漏气、皮下水肿、血肿、局部感染）和拔管时间无显著差异。148 名无术后并发症患者的平均引流量为 78.3±10.9ml。术后 8 小时和 32 小时的累计引流分别占总引流的 53.2%和 91.9%。术后 32 小时的残留引流估计为 6.5±2.9ml（P95=11.0ml）。建立了总容量（V）与切除组织大小（S）之间的线性回归方程：V=1.625S+56.604（p=0.0001）。
在 TOETVA 中，小引流管可以提供良好的美容效果和可靠的引流。伤口的主要渗出期在术后 8 小时内。如果认为残留量小于 11ml 是可自行吸收的，则 95%的患者最短的安全拔管时间应为术后 32 小时。
