甲状腺乳头状癌术后不放置引流管的临床效果及围术期管理

Effect of no drainage after thyroidectomy for papillary thyroid carcinoma and perioperative management strategies

目的探讨甲状腺乳头状癌术后不放置引流管的效果及围术期管理方法。方法选取2019年3月至2019年10月间中国医学科学院北京协和医学院肿瘤医院收治的行甲状腺切除及中央区淋巴结清扫手术的256例甲状腺乳头状癌患者。根据患者术后是否放置引流管进行分组,不放置引流管的128例患者纳入不放置引流管组,放置引流管的128例患者纳入放置引流管组。比较两组患者的皮下血肿、皮下积液和切口感染发生情况,及下床活动时间、疼痛、睡眠、术后住院时间及住院费用的情况。结果放置引流管组患者发生皮下血肿1例,皮下积液1例,切口感染1例;不放置引流管组患者发生皮下血肿0例,皮下积液2例,切口感染0例,两组患者术后皮下血肿、皮下积液及切口感染发生情况比较,差异无统计学意义(P>0.05)。术后不放置引流管组与放置引流管组相比,下床活动早、疼痛评分低、睡眠时间长、术后住院时间短、住院费用少,差异均有统计学意义(均P<0.05)。结论甲状腺乳头状癌行甲状腺切除和中央区淋巴结清扫手术的患者术后不放置引流管具有一定优势,但需要针对性进行围术期管理。

Objective To explore the effect of no drainage after thyroidectomy for papillary thyroid carcinoma and perioperative management strategies.Methods A total of 256 patients with papillary thyroid cancer undergoing thyroidectomy and central lymph node dissection at Cancer Hospital,Chinese Academy of Medical Sciences Peking Union Medical College were selected from March 2019 to October 2019.They were divided into groups based on whether drainage tube was placed after the surgery.One hundred and twentyeight patients receiving drainage after surgery were included in a drainage group and 128 patients who did not receive drainage were included in a drainless group.Incidence of subcutaneous hematoma and effusion and postoperative infection,time to out-of-bed activity,pain,sleep,length of hospital stay and costs of hospital were compared between the two groups.Results Subcutaneous hematoma occurred in 1 patient,subcutaneous effusion occurred in 1 patient,and incision infection occurred in 1 patient in the drainage group.None of the patient was found to have subcutaneous hematoma,2 patients were found to have subcutaneous effusion and no incision infection occurred in the drainless group.There was no statistically significant difference in the incidence of subcutaneous hematoma,subcutaneous effusion,and incision infection between the two groups(P>0.05).Time to out-of-bed activity was short,pain score was low,sleep time was long,length of hospital stay was short and costs the hospital care was low in the drainless group than in the drainage group(all P<0.05).Conclusion For patients with papillary thyroid carcinoma undergoing thyroidectomy and central lymph node dissection,there is a certain advantage for no drainage,and it requires targeted perioperative management.