Kunduz Enver, Aysan Erhan, İdiz Ufuk Oğuz, Ersoy Yeliz Emine, Bektaşoğlu Hüseyin Kazım, Yığman Samet, Kundakcıoğlu Hacer
Bezmialem Vakıf Üniversitesi Tıp Fakültesi, Genel Cerrahi Anabilim Dalı, İstanbul, Türkiye.
İstanbul Eğitim ve Araştırma Hastanesi, Genel Cerrahi Kliniği, İstanbul, Türkiye.
Turk J Surg. 2019 Mar 1;35(1):49-53. doi: 10.5578/turkjsurg.4162. eCollection 2019 Mar.
Bleeding is a rare and dangerous complication of thyroid surgery. One of the hemostatic agents used during surgery are microporous polysaccharide hemospheres (MPH) which are local hemostatic agents acquired from purified potato starch. The aim of this study was to evaluate the efficiency of two MPH, produced with different biotechniques, in decreasing hemorrhages and drainage following thyroidectomy.
A statistical power analysis predicted that totally 20 patients per each group was needed within 95% confidential interval. Patients were randomized into 3 groups as control, Haemocer TM and Arista TM to be 20 patients in each group. Following bilateral total thyroidectomy, no additional procedures were performed in the first group, 5 g Haemocer was administered to the second group, 5 g Arista was administered to the third group into the operational field, and the operation was ended by placing a double-sided hemovac drain. At post-operative day one, drainage amount, calcium (Ca), phosphate (P) and parathyroid hormone (PTH) levels were noted.
No significant difference was noted between the groups for age, gender, removed tissue weight and malignant pathology rates. Also, no significant difference was noted between post-operative drainages and Ca, P, PTH levels of groups either. Hoarseness or hematoma were not observed in any patient.
MPHs are not proven in effectiveness in decreasing post-operative hemorrhages, which might be a key to avoiding unnecessary expenses.
出血是甲状腺手术罕见且危险的并发症。手术中使用的止血剂之一是微孔多糖微球(MPH),它是一种从纯化马铃薯淀粉中提取的局部止血剂。本研究的目的是评估两种采用不同生物技术生产的MPH在减少甲状腺切除术后出血和引流方面的效果。
一项统计功效分析预测,在95%置信区间内每组总共需要20例患者。患者被随机分为3组,即对照组、Hemocer TM组和Arista TM组,每组20例。双侧全甲状腺切除术后,第一组不进行额外操作,第二组在术野中给予5 g Hemocer,第三组给予5 g Arista,然后放置双侧负压引流管结束手术。术后第1天,记录引流量、钙(Ca)、磷(P)和甲状旁腺激素(PTH)水平。
各组在年龄、性别、切除组织重量和恶性病理发生率方面无显著差异。此外,各组术后引流以及Ca、P、PTH水平之间也无显著差异。所有患者均未出现声音嘶哑或血肿。
MPH在减少术后出血方面的有效性尚未得到证实,这可能是避免不必要费用的关键。