Manjunatha H A, Prashanth K B, Ranjani S K, Kumar Ajay S, Divya K Purna
Department of Otorhinolaryngology, J J M Medical College, Davangere, Karnataka India.
Indian J Otolaryngol Head Neck Surg. 2023 Sep;75(3):1681-1686. doi: 10.1007/s12070-023-03700-w. Epub 2023 Mar 25.
Most of the thyroid surgeries are accompanied by drain placement. The possibility of hematoma or seroma formation postoperatively is of concern to surgeons, as, thyroid is a highly vascular structure and a minor hemorrhage might also turn out to be life threatening, despite actual incidence of it being only 0.3-1%. Thus, drains are placed with an intention to obliterate dead space and clear the collecting blood or serum. Conversely, several studies have indicated chances of clots blocking the drainage tube and resulting in missing out of early detection of a massive bleed. Drains have also been known to add more discomfort to the patient, increase chances of infection, increase post operative pain, scar formation and longer duration of hospital stay. Thus, some surgeons believe in not placing a drain. To compare the outcomes of thyroid surgeries done with drain versus those thyroid surgeries done without drain. 40 patients, of either sex, between 18 and 70 years of age, who underwent thyroid surgeries for various thyroid disorders over a period of 6 months, were randomly allocated to either 'with drain' (group A) or 'without drain' (group B). The surgeon was made aware of drain status only intraoperatively. Patients were assessed for post-operative pain based on Visual Analogue Scale (VAS) at 6 and 24 h post-operatively. Post-operative complications including hematoma, seroma, and wound infection, if any, along with duration of hospitalization, were also documented. Patient was followed up one week post-operatively for wound check and suture removal. Both groups were homogenous according to age, sex, TIRADS, Bethesda, diagnosis and surgery performed. Postoperative pain at 6 and 24 h was significantly higher in group A than in group B [6.15 ± 1.31 vs 3.50 ± 0.88 ( = 0.001) (6 h), 4.45 ± 0.99 vs 1.20 ± 1.10 ( = 0.001) (24 h)]. Mean duration of hospitalization following thyroid surgery was significantly higher among group A than group B [3.80 ± 1.15 vs 2.15 ± 0.36 days ( = 0.001)]. Though not statistically significant, wound pain at 1 week and overall complications were higher in Group A than in Group B ( = 0.182, = 0.127 respectively). Thyroid surgeries done without drain placement are likely to cause significantly lesser post-operative pain and shorter duration of hospitalization.
大多数甲状腺手术都需要放置引流管。术后形成血肿或血清肿的可能性是外科医生所关注的，因为甲状腺是一个血管丰富的结构，即使其实际发生率仅为0.3 - 1%，轻微出血也可能危及生命。因此，放置引流管的目的是消除死腔并清除积聚的血液或血清。相反，多项研究表明，血凝块有堵塞引流管的可能，从而导致无法早期发现大出血。众所周知，引流管还会给患者带来更多不适，增加感染几率，加剧术后疼痛、瘢痕形成以及延长住院时间。因此，一些外科医生认为不放置引流管。为比较放置引流管的甲状腺手术与不放置引流管的甲状腺手术的效果。在6个月的时间里，40例年龄在18至70岁之间、因各种甲状腺疾病接受甲状腺手术的患者，被随机分为“有引流管”组（A组）和“无引流管”组（B组）。仅在手术过程中让外科医生知晓引流管情况。术后6小时和24小时，根据视觉模拟评分法（VAS）对患者的术后疼痛进行评估。还记录了术后并发症，包括血肿、血清肿和伤口感染（如有）以及住院时间。术后一周对患者进行随访，检查伤口并拆线。两组在年龄、性别、甲状腺影像报告和数据系统（TIRADS）、贝塞斯达分类、诊断及所进行的手术方面具有同质性。A组术后6小时和24小时的疼痛明显高于B组[6.15±1.31对3.50±0.88（P = 0.001）（6小时），4.45±0.99对1.20±1.10（P = 0.001）（24小时）]。甲状腺手术后A组的平均住院时间明显长于B组[3.80±1.15对2.15±0.36天（P = 0.001）]。虽然无统计学意义，但A组术后1周的伤口疼痛和总体并发症高于B组（分别为P = 0.182，P = 0.127）。不放置引流管的甲状腺手术可能会显著减轻术后疼痛并缩短住院时间。
