经胸乳径路内镜甲状腺手术后并发血清肿的预防和处理策略

Management and preventive strategies for seroma formation following breast approach endoscopic thyroidectomy: an analysis of 10 cases

目的总结经胸乳径路内镜甲状腺术后并发胸前壁血清肿的防治经验。方法回顾性分析2001年7月至2008年2月第二军医大学长征医院微创外科中心经胸乳径路内镜甲状腺手术(breast approach endoscopic thyroidectomy,BAET)后并发血清肿的临床资料,评估分析病例组与对照组的危险因素,划分高风险人群。结果BAET后血清肿发生率为2.9%(10/344),10例病人均在术后1个月内出现血清肿(7例血清肿范围局限,3例波及颈前区)。9例病人采取及时处理,血清肿迅速治愈,1例处理较迟且不彻底,血清肿部分隆起,明显影响颈前外观。Logistic回归分析提示年龄、体重、体重指数、高血压、胸前壁分离范围、拔管方法与血清肿形成有关;结论针对危险因素进行病因预防是减少血清肿形成的关键,早期发现并及时彻底处理血清肿,是取得良好疗效的关键。

Objective To evaluate the management and to provide the preventive strategies for seroma formation following endoscopic thyroidectomy via breast approach. Methods The characteristics and outcomes of patients developed seroma following endoscopic thyroidectomy via breast approach between July 2001 and February 2008 at Chang Zheng Hospital Affiliated to Second Military Medical University were analyzed retrospectively. All the data were compared with those without seroma. Regression analysis was performed to identify the independent risk factors for seroma. Results The postoperative incidence of seroma formation was 2.9%（10/344）. There was significant difference in seroma formation based on age, hypertension, body mass index （BMI）, area of subcutaneous dissection space and suction removal method. All 10 cases developed seroma in the first month after surgery. Seroma in 7 cases were localized while the areas of other 3 cases were much extensive, even up to the neck. Nine cases were healed quickly with immediate treatment. However,1 cases met decreased cosmetic result because of delayed and uncompleted therapy. Conclusion Preventive strategies should be designed according to the risk factors of seroma formation after BAET. It is necessary to make early diagnosis and treatment for patients with seroma.