Majadla Omar, Pitaro Jacob, Gavriel Haim, Muallem Kalmovich Limor
Otolaryngology - Head and Neck Surgery, Shamir Medical Center (Assaf Harofeh), Be'er Ya'akov, ISR.
Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, ISR.
Cureus. 2024 Jun 11;16(6):e62147. doi: 10.7759/cureus.62147. eCollection 2024 Jun.
Using liquid fibrin sealants has once again questioned the benefit of drain placement in head and neck operations. Cellulose-based hemostats offering different hemostasis mechanisms have scarcely been investigated in drainless neck surgeries. This study aimed to evaluate whether liquid fibrin sealant offers any advantage over cellulose-based hemostats in various head and neck surgeries.
A prospective trial of patients who underwent various neck surgeries between 2020 and 2022. Baseline characteristics and postoperative outcomes were compared between the drain-placed and the drainless groups, with the latter sub-categorized into three groups: fibrin sealant, cellulose-based hemostats, and a combination of both.
A total of 119 patients were included (63 thyroidectomies, 40 parathyroidectomies, and 16 sialoadenectomies). Fifty eight had a drain placed and 61 had no drain. In the drainless group, 23 patients received cellulose-based absorbable hemostats (SURGICEL®/ FIBRILLAR™); 18 patients had fibrin sealants (EVICEL®/TachoSil®/TISSEEL); in 16, a combination of both was used; and in four patients, no hemostatic agent was used. Three (5%) of the 61 drainless patients developed a seroma compared to one (2%) seroma in the drain-placed patients. No advantage was demonstrated using a combination of FIBRILLAR™ with a fibrin sealant nor for any used separately. Drain placement delayed patient discharge by at least one day compared to the group without a drain (p < 0.001).
Drain placement offered a minor advantage in the postoperative course reducing rates of seroma formation, while delaying patient discharge by at least one day. There was no advantage in using a specific hemostatic agent over the other.
使用液体纤维蛋白封闭剂再次引发了对头颈部手术中放置引流管益处的质疑。在无引流管的颈部手术中，对具有不同止血机制的纤维素基止血剂的研究很少。本研究旨在评估在各种头颈部手术中，液体纤维蛋白封闭剂相对于纤维素基止血剂是否具有任何优势。
对2020年至2022年间接受各种颈部手术的患者进行前瞻性试验。比较放置引流管组和无引流管组的基线特征和术后结果，后者又分为三组：纤维蛋白封闭剂组、纤维素基止血剂组和两者联合使用组。
共纳入119例患者（63例行甲状腺切除术，40例行甲状旁腺切除术，16例行涎腺切除术）。58例放置了引流管，61例未放置引流管。在无引流管组中，23例患者使用了纤维素基可吸收止血剂（SURGICEL®/FIBRILLAR™）；18例患者使用了纤维蛋白封闭剂（EVICEL®/TachoSil®/TISSEEL）；16例患者联合使用了两者；4例患者未使用任何止血剂。61例无引流管患者中有3例（5%）出现血清肿，而放置引流管的患者中有1例（2%）出现血清肿。未证明FIBRILLAR™与纤维蛋白封闭剂联合使用或单独使用有任何优势。与未放置引流管的组相比，放置引流管使患者出院延迟至少一天（p < 0.001）。
放置引流管在术后过程中具有轻微优势，可降低血清肿形成率，但会使患者出院延迟至少一天。使用特定的止血剂并不比其他止血剂有优势。
