Shetty Teertha, Joshi Poonam, Talole Sanjay, Nair Sudhir, Chaturvedi Pankaj
Department of Head and Neck Surgery, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Hospital, Homi Bhabha National Institute, PS Building, ACTREC, Kharghar, Navi Mumbai, Mumbai, Maharashtra 410210 India.
J Maxillofac Oral Surg. 2024 Aug;23(4):966-971. doi: 10.1007/s12663-024-02123-6. Epub 2024 Feb 23.
Advanced oral carcinoma surgery results in large denuded areas leading to seroma and hematoma. Closed suction drains obliterate dead space and create negative pressure on wound bed. Non-placement or early removal of drain can lead to various complications, while placement for long duration can cause surgical site infection. The study aims to evaluate factors affecting postoperative neck drain volume, guiding surgeons for decision making for time of drain removal.
The study comprised of 222 patients with oral squamous cell carcinoma who underwent primary tumor resection and neck dissection. Demographical, clinical, and surgical details were retrospectively analyzed.
The mean age of patients was 49.1 years. Majority of patients had advanced disease requiring extensive surgery. Patients with radical neck dissection and those reconstructed with pedicled flap had statistically significant drain volume as compared to those with selective neck dissection and free flaps, respectively. Patients with longer duration of surgery, higher blood loss, low postoperative albumin value, and complications showed increased drain volume. Mean duration of drain removal was 7 days, and all drains were removed by day 10.
Advanced stage primary disease, radical and modified neck dissections, PMMC flap reconstruction, longer duration of surgery, and higher blood loss had higher drain output. Thus, patient parameters, tumor factors, and surgery factors influence drain output and hospitalization.
Diligent preoperative and perioperative assessment of various factors can aid trainee surgeons to make decisions for appropriate time for drain removal.
晚期口腔癌手术会导致大面积裸露区域，进而引发血清肿和血肿。封闭式负压引流可消除死腔并在伤口床形成负压。不放置引流管或过早拔除引流管可能导致各种并发症，而长时间放置则可能引起手术部位感染。本研究旨在评估影响术后颈部引流量的因素，为外科医生决定引流管拔除时间提供指导。
本研究纳入了222例行原发性肿瘤切除及颈部淋巴结清扫术的口腔鳞状细胞癌患者。对患者的人口统计学、临床及手术细节进行回顾性分析。
患者的平均年龄为49.1岁。大多数患者患有晚期疾病，需要进行广泛手术。与选择性颈部淋巴结清扫术和游离皮瓣患者相比，行根治性颈部淋巴结清扫术和带蒂皮瓣重建的患者引流量具有统计学意义。手术时间较长、失血量较多、术后白蛋白值较低以及出现并发症的患者引流量增加。引流管拔除的平均时间为7天，所有引流管均在第10天前拔除。
晚期原发性疾病、根治性和改良根治性颈部淋巴结清扫术、胸大肌肌皮瓣重建、较长的手术时间以及较多的失血量导致更高的引流量。因此，患者参数、肿瘤因素和手术因素会影响引流量和住院时间。
对各种因素进行认真的术前和围手术期评估，有助于实习外科医生决定合适的引流管拔除时间。
