Liu Z Y, Peng X W, Li Z, Zhou B, Lyu C L, Wu P, Tang Y Y, Peng W, Li H, Ou Y
Department of Oncology Plastic Surgery/Head and Neck Surgery, Hunan Cancer Hospital, the Affiliated Cancer Hospital of Xiangya Medical School, Central South University, Changsha 410013, China.
Zhonghua Wai Ke Za Zhi. 2020 Nov 1;58(11):870-875. doi: 10.3760/cma.j.cn112139-20191026-00531.
To examine the feasibility of small drain in transoral endoscopic thyroidectomy vestibular approach (TOETVA). A prospective research was performed in Department of Oncology Plastic Surgery/Head and Neck Surgery, Hunan Cancer Hospital, from October 2018 to March 2019. Totally 103 patients who met the inclusion and exclusion criteria, signed the operation agreement of TOETVA, had their surgery completed and followed-up over 6 months, were enrolled in analysis. A central venous catheter was used as a drain tube in all cases (outer diameter 1.7 mm, inner diameter 1.0 mm). Visual analogue scale (VAS) was applied for assessing pain scores during the first 24 hours after the operation. Vancouver scar scale (VSS) was used for assessing the scar left by the drainage. The drainage volume (minimum scale:10 ml, approximate read: 1 ml) was recorded every 2 hours during the first postoperative 12 hours, every 4 hours during 12 to 24 hours, every 8 hours during 24 to 48 hours, and once from 48 hours until extubation. The volume of drainage, the cumulative volume and the percentage of cumulative volume accounting for the total volume were calculated. The data of residual volume (subtract the cumulative volume from the total volume) in the postoperative 24, 32 and 40 hours were analyzed, and their upper one-side was calculated by percentile method. There were 12 males and 91 females. The age was (36.6±9.7) years (range: 18 to 58 years). The intraoperative tube-inserting time was (10.1±2.6) minutes (range: 6 to 18 minutes). The pain score on the first day was 2.7±1.1 (range: 1 to 5). The extubation time was (2.7±0.5) days (range: 2 to 4 days). VSS scores in the postoperative 1(st) month and 6(th) month were 2.9±1.3 (range: 0 to 7) and 0(2)(()), respectively. The size of the scar was 0 (2.5) mm in the postoperative 6(th) month. Sixty-four patients had no visible scars. There were 5 patients who had postoperative drain-related complications (1 for air leakage, 1 for tube blockage, 3 for subcutaneous hydrop, 2 for regional infection), who were all cured after proper treatment. The total volume of drainage for 98 patients without postoperative drain-related complications was (80.1±12.2) ml (range: 58 to 131 ml). The cumulative drainage within 8 hours accounted for (53.8±4.2)% (range: 41.0% to 62.9%) of the total drainage. The volume of residual fluids in the postoperative 32 hours was estimated to (5.8±2.7) ml (range: 0 to 12 ml,=10.0 ml). The small drain tubecan be applied in TOETVA, providing a satisfied cosmetic appearance and a reliable drainage. The main exudation period of the wound is within 8 hours after the operation. If a residual volume less than 10 ml is considered to be self-absorbable, the shortest safe extubation point for 95% patients without drain-related complications should be 32 hours after the operation.
探讨经口内镜甲状腺手术前庭入路（TOETVA）中使用小引流管的可行性。2018年10月至2019年3月在湖南省肿瘤医院肿瘤整形外科/头颈外科进行了一项前瞻性研究。共有103例符合纳入和排除标准、签署了TOETVA手术协议、手术完成且随访超过6个月的患者纳入分析。所有病例均使用中心静脉导管作为引流管（外径1.7mm，内径1.0mm）。采用视觉模拟评分法（VAS）评估术后24小时内的疼痛评分。使用温哥华瘢痕量表（VSS）评估引流留下的瘢痕。术后12小时内每2小时记录一次引流量（最小刻度：10ml，近似读数：1ml），12至24小时每4小时记录一次，24至48小时每8小时记录一次，48小时至拔管期间记录一次。计算引流量、累积量以及累积量占总量的百分比。分析术后24、32和40小时的残余量（总量减去累积量）数据，并采用百分位数法计算其上单侧值。男性12例，女性91例。年龄为（36.6±9.7）岁（范围：18至58岁）。术中置管时间为（10.1±2.6）分钟（范围：6至18分钟）。第一天的疼痛评分为2.7±1.1（范围：1至5）。拔管时间为（2.7±0.5）天（范围：2至4天）。术后第1个月和第6个月的VSS评分分别为2.9±1.3（范围：0至7）和0（2）（（））。术后第6个月瘢痕大小为0（2.5）mm。64例患者无可见瘢痕。有5例患者出现术后引流相关并发症（1例漏气、1例堵管、3例皮下积液、2例局部感染），经适当治疗后均治愈。98例无术后引流相关并发症患者的总引流量为（80.1±12.2）ml（范围：58至131ml）。8小时内的累积引流量占总引流量的（53.8±4.2）%（范围：41.0%至62.9%）。术后32小时的残余液体量估计为（5.8±2.7）ml（范围：0至12ml，=10.0ml）。小引流管可应用于TOETVA，能提供满意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。如果将残余量小于10ml视为可自行吸收，那么95%无引流相关并发症患者的最短安全拔管时间应为术后32小时。
