Kim Seong Hoon, Ahn Jong Hyuk, Yoon Hye Jeong, Kim Jae Hwan, Hwang Young Mi, Choi Yun Suk, Yi Jin Wook
Department of Surgery, Inha University Hospital & College of Medicine, Incheon 22332, Korea.
Department of Surgery, Chungbuk National University Hospital, Cheongju 28644, Korea.
Cancers (Basel). 2022 Aug 12;14(16):3901. doi: 10.3390/cancers14163901.
Papillary thyroid cancer (PTC) is the most common type of thyroid cancer. Surgery for PTC involves resection of the thyroid gland and central lymph node dissection. Central lymph node dissection is associated with an increased amount of fluid from the dissection area and chyle leakage due to thoracic duct injury. There are few studies that deal with reducing fluid drainage and preventing chyle leakage after thyroid surgery with central lymph node dissection. A polyglycolic acid mesh sheet (Neoveil™) has been demonstrated to prevent postoperative fluid leakage in other surgeries. This study aims to evaluate whether a polyglycolic acid mesh sheet can reduce postoperative drainage and chyle leakage in papillary thyroid cancer surgery, and this study was designed as a prospective, open-label, randomized controlled trial in a single university hospital. The patients were randomly assigned to having only fibrin glue used in the central node dissection area (control group) or to having a polyglycolic acid mesh sheet applied after fibrin glue (treatment group). A total of 330 patients were enrolled, of which 5 patients were excluded. A total of 161 patients were included in the treatment group, and 164 patients were included in the control group. The primary outcome was the drainage amount from the Jackson-Pratt drain, and the secondary outcome was the triglyceride level in the drained fluid on the 1st and 2nd postoperative days. The drainage amount was significantly lower in the treatment group on the 2nd postoperative day (60.9 ± 34.9 mL vs. 72.3 ± 38.0 mL, = 0.005). The sum of drainage amount during the whole postoperative days (1st and 2nd days) was also significantly lower in the treatment group (142.7 ± 71.0 mL vs. 162.5 ± 71.5 mL, = 0.013). The postoperative triglyceride levels were lower in the treatment group but were not statistically significant (92.1 ± 60.1 mg/dL vs. 81.3 ± 58.7 mg/dL on postoperative day 1, = 0.104 and 67.6 ± 99.2 mg/dL vs. 53.6 ± 80.4 mg/dL on postoperative day 2, = 0.162). No adverse effects were observed in the treatment groups during the postoperative 9-month follow-up. Our study suggests that polyglycolic acid mesh sheets can be safely applied to reduce postoperative drainage amount in thyroidectomy patients who need lymph node dissection.
乳头状甲状腺癌（PTC）是最常见的甲状腺癌类型。PTC手术包括甲状腺切除和中央淋巴结清扫。中央淋巴结清扫会导致清扫区域的液体量增加以及因胸导管损伤引起的乳糜漏。很少有研究涉及减少甲状腺手术伴中央淋巴结清扫术后的引流液并预防乳糜漏。聚乙醇酸网片（Neoveil™）已被证明可预防其他手术中的术后液体渗漏。本研究旨在评估聚乙醇酸网片是否能减少乳头状甲状腺癌手术中的术后引流液及乳糜漏，本研究设计为在一家大学医院进行的前瞻性、开放标签、随机对照试验。患者被随机分配至仅在中央淋巴结清扫区域使用纤维蛋白胶（对照组）或在使用纤维蛋白胶后应用聚乙醇酸网片（治疗组）。共纳入330例患者，其中5例被排除。治疗组共纳入161例患者，对照组纳入164例患者。主要结局指标是Jackson-Pratt引流管的引流量，次要结局指标是术后第1天和第2天引流液中的甘油三酯水平。术后第2天治疗组的引流量显著更低（60.9±34.9 mL对72.3±38.0 mL，P = 0.005）。术后整个时间段（第1天和第2天）的引流总量在治疗组中也显著更低（142.7±71.0 mL对162.5±71.5 mL，P = 0.013）。治疗组术后甘油三酯水平更低，但无统计学意义（术后第1天92.1±60.1 mg/dL对81.3±58.7 mg/dL，P = 0.104；术后第2天67.6±99.2 mg/dL对53.6±80.4 mg/dL，P = 0.162）。在术后9个月的随访期间，治疗组未观察到不良反应。我们的研究表明，聚乙醇酸网片可安全应用于减少需要淋巴结清扫的甲状腺切除患者的术后引流量。
