Daou R
Service de Chirurgie maxillo-faciale, CHU Strasbourg.
Chirurgie. 1997;122(7):408-10.
Recent randomized series did not support routine prophylactic drainage after thyroidectomy. We undertook a prospective study in order to evaluate the effectiveness and the morbidity of a non drainage strategy after thyroidectomy. Between april 1993 and may 1995, one hundred fifty consecutive patients underwent thyroidectomy without drainage. During this period, two thyroid cancers were treated by total thyroidectomy with a modified radical neck dissection and drainage; they are not included in the study. Age range was 16 to 72 years. Sex ratio was 126F/124M. Indication for surgery was: solitary nodule (16), multinodular goiter (56), Graves' disease (21), toxic nodular goiter (34), cancer (8), retrosternal goiter (13), thyroiditis (2). The surgery done was: total lobectomy + isthmusectomy (15), total lobectomy + subtotal controlateral thyroidectomy (42), bilateral subtotal thyroidectomy (84), total thyroidectomy (9). Surgical technique was identical to that used previously by the author when drainage was installed routinely. Patients left the hospital on the first or second postoperative day and were reexamined on day 7 and day 30. There was no mortality, no suffocating hematoma, no reoperation and no laryngeal nerve paralysis. One patient developed a transient hypocalcemia that regressed one month later. Two patients developed a minor hematoma of which one disappeared after two weeks and the other drained spontaneously through the surgical incision on the seventh postoperative day. We conclude that drainage after thyroidectomy has no adverse effects and can be avoided if meticulous surgery is done. Absence of drainage simplifies the early postoperative course, improves the comfort of the patient, decreases hospital stay and reduces hospital cost. However, drainage may be of value in case of hemostatic problems or associated cervical neck dissection.
近期的随机系列研究并不支持甲状腺切除术后常规预防性引流。我们进行了一项前瞻性研究，以评估甲状腺切除术后不引流策略的有效性和发病率。1993年4月至1995年5月期间，150例连续患者接受了不引流的甲状腺切除术。在此期间，有2例甲状腺癌患者接受了全甲状腺切除加改良根治性颈清扫及引流术；这2例患者未纳入本研究。年龄范围为16至72岁。男女比例为126例女性/124例男性。手术指征为：孤立结节（16例）、多结节性甲状腺肿（56例）、格雷夫斯病（21例）、毒性结节性甲状腺肿（34例）、癌症（8例）、胸骨后甲状腺肿（13例）、甲状腺炎（2例）。所施行的手术为：全叶切除+峡部切除（15例）、全叶切除+对侧次全甲状腺切除（42例）、双侧次全甲状腺切除（84例）、全甲状腺切除（9例）。手术技术与作者之前常规放置引流时所使用的技术相同。患者于术后第1天或第2天出院，并在第7天和第30天接受复查。无死亡病例，无窒息性血肿，无需再次手术，无喉返神经麻痹。1例患者出现短暂性低钙血症，1个月后恢复。2例患者出现轻微血肿，其中1例在2周后消失，另1例在术后第7天通过手术切口自行引流。我们得出结论，如果手术操作细致，甲状腺切除术后引流无不良影响且可避免。不放置引流可简化术后早期病程，提高患者舒适度，缩短住院时间并降低住院费用。然而，在存在止血问题或联合颈部淋巴结清扫的情况下，引流可能有价值。
