Shaha A R, Jaffe B M
Department of Surgery, SUNY Health Science Center at Brooklyn.
J Surg Oncol. 1994 Dec;57(4):235-8. doi: 10.1002/jso.2930570406.
Thyroid diseases and surgery for thyroid neoplasms are both very common. Several complications of thyroidectomy are well known. Some of these are quite disturbing, such as recurrent laryngeal nerve injury and permanent hypoparathyroidism. However, postoperative hematoma often in the recovery room may be fatal. Close observation and early intervention are of utmost necessity in the post-thyroidectomy period. In a series of 600 thyroidectomies performed over a period of 11 years, eight patients developed postoperative hematoma. Seven of them underwent re-exploration, while one patient was treated conservatively. Two patients had second re-exploration for hematoma reaccumulation. All patients recovered very well after re-exploration except one elderly patient who required ventilatory support due to poor pulmonary reserve; after a week of ventilatory support and a tracheostomy, she too recovered well. One patient had the hematoma re-explored as late as 24 hours after the operation, while the remainder were re-explored within 4-6 hours after the initial procedure. Because of the extent of edema of the larynx and pharyngeal wall, it is very important that a senior, experienced person perform intubation in these patients. It is also very important to recognize that when the patients lie down flat, they may develop acute airway distress; hence, one must be prepared to intubate them emergently. We recommend close recovery room observation after thyroidectomy and early exploration and evacuation of hematoma in all patients who develop postoperative hematoma. A conservative approach may be considered in selected patients with minimal hematoma and no progression. However, it generally takes a long time for the hematoma to resorb. A better understanding of the complications of thyroidectomy will minimize morbidity and make thyroidectomy a safer procedure and a surgical triumph.
甲状腺疾病以及甲状腺肿瘤手术都非常常见。甲状腺切除术的几种并发症广为人知。其中一些并发症相当令人困扰，比如喉返神经损伤和永久性甲状旁腺功能减退。然而，术后常在恢复室出现的血肿可能是致命的。在甲状腺切除术后密切观察并尽早干预至关重要。在11年期间进行的一系列600例甲状腺切除术中，有8例患者出现了术后血肿。其中7例接受了再次探查，1例患者接受了保守治疗。2例患者因血肿再次积聚进行了二次探查。除1例因肺储备功能差需要通气支持的老年患者外，所有患者在再次探查后恢复良好；经过一周的通气支持和气管切开术后，她也恢复得很好。1例患者在术后24小时才对血肿进行再次探查，其余患者在初次手术后4 - 6小时内进行了再次探查。由于喉和咽壁的水肿程度，由经验丰富的资深人员对这些患者进行插管非常重要。同样重要的是要认识到，当患者平躺时，他们可能会出现急性气道窘迫；因此，必须做好紧急为他们插管的准备。我们建议甲状腺切除术后在恢复室密切观察，对于所有出现术后血肿的患者尽早探查并清除血肿。对于血肿最小且无进展的特定患者，可以考虑采取保守方法。然而，血肿吸收通常需要很长时间。更好地了解甲状腺切除术的并发症将使发病率降至最低，并使甲状腺切除术成为更安全的手术以及手术的成功范例。
