Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA.
Department of Surgery, University of Wisconsin, Madison, WI, USA.
Updates Surg. 2020 Dec;72(4):1135-1141. doi: 10.1007/s13304-020-00776-9. Epub 2020 Apr 24.
Postoperative neck hematomas following thyroidectomy occur in up to 6.5% of cases. It is unclear whether the use of energy vessel sealant devices effects the rate of PNH. We hypothesized use of an EVSD to be associated with decreased risk of PNH in patients undergoing thyroidectomy. The 2016-2017 American College of Surgeons Thyroidectomy database was queried for patients undergoing thyroidectomy with and without EVSDs. A multivariable logistic regression analysis was performed to evaluate for risk of PNH. From 11,355 patients undergoing thyroidectomy, an EVSD was used for 7460 (65.7%) patients. Age distribution was similar between the two groups (52 vs. 53-years old, p = 0.467). Compared to patients without EVSD used, patients with EVSD used had higher rates of comorbid hypertension (40.6% vs. 34.8%, p < 0.001) and diabetes (14.2% vs. 11.5%, p < 0.001); however, a lower rate of PNH (1.4% vs. 2.4%, p < 0.001). After adjusting for known risk factors for PNH including age, prior neck surgery, and comorbidities, EVSD use was associated with a decreased risk of PNH (OR 0.453, 95% CI 0.330-0.620, p < 0.001). The strongest associated risk factors for PNH were hypertension (OR 1.823, 95% CI 1.283-2.591, p = 0.001) and toxic goiter (OR 1.837, 95% CI 1.144-2.949, p = 0.012). When compared to standard vessel ligation, EVSD use was associated with a lower risk of PNH in patients undergoing thyroidectomy. The strongest associated risk factor for PNH was toxic goiter. Future prospective research is needed to confirm these findings and if corroborated, then increased use of an EVSD should be employed.
甲状腺切除术后的颈部血肿发生率高达 6.5%。目前尚不清楚使用血管封闭装置是否会影响 PNH 的发生率。我们假设在甲状腺切除术患者中使用 EVSD 可降低 PNH 的风险。2016-2017 年美国外科医师学会甲状腺切除术数据库中检索了行甲状腺切除术且未使用 EVSD 的患者。使用多变量逻辑回归分析评估 PNH 的风险。在 11355 例行甲状腺切除术的患者中，有 7460 例（65.7%）患者使用了 EVSD。两组患者的年龄分布相似（52 岁 vs. 53 岁，p=0.467）。与未使用 EVSD 的患者相比，使用 EVSD 的患者中合并高血压的发生率更高（40.6% vs. 34.8%，p<0.001）和糖尿病（14.2% vs. 11.5%，p<0.001）；然而，PNH 的发生率更低（1.4% vs. 2.4%，p<0.001）。在调整已知的 PNH 危险因素，包括年龄、颈部既往手术和合并症后，EVSD 的使用与 PNH 的风险降低相关（OR 0.453，95%CI 0.330-0.620，p<0.001）。与 PNH 最相关的危险因素是高血压（OR 1.823，95%CI 1.283-2.591，p=0.001）和毒性甲状腺肿（OR 1.837，95%CI 1.144-2.949，p=0.012）。与标准血管结扎相比，EVSD 的使用与甲状腺切除术患者 PNH 的风险降低相关。与 PNH 最相关的危险因素是毒性甲状腺肿。需要进一步前瞻性研究来证实这些发现，如果得到证实，那么应增加 EVSD 的使用。
