甲状腺癌手术后不留置引流管的安全性和可行性分析

目的:探讨甲状腺癌根治术后不留置引流管的安全性和可行性。方法:选择从2013年09月到2019年07月在我院行甲状腺癌根治术后未留置引流管的75例患者。根据手术时间分为三个阶段:第一阶段，包括15例行单侧腺叶切除术的患者；第二阶段，包括14例患者，其中9例行单侧腺叶切除术，3例行单侧腺叶切除+颈中央组淋巴结清扫术，2例行全甲状腺切除+颈中央组淋巴结清扫术；第三阶段，包括46例患者，其中44例行单侧腺叶或全甲状腺切除+单侧或双侧颈中央组淋巴结清扫术，2例行单侧腺叶切除术。收集患者的一般资料，并进行随访。结果:75例患者中有分化型甲状腺癌74例（乳头状癌72例，滤泡状癌2例），髓样癌1例。第一、二和三阶段手术平均时间分别为（116.67±28.07）分钟、（129.29±36.31）分钟和（153.91±35.84）分钟，术中平均出血量分别为（34.33±47.09） mL、（29.29±24.09） mL和（28.70±15.03） mL，术后平均住院时间分别为（1.80±0.77）天、（2.29±1.64）天和（2.30±1.41）天。仅有第一阶段和第三阶段在手术平均时间方面存在显著性差异，其余各组间无明显统计学差异。术后血肿形成、喉返神经损伤和甲状旁腺损伤分别发生1例（1.3%）、2例（2.7%）和30例（40.0%）。均无因术后并发症需再次手术的情况。术后随访12~76个月，其中对侧甲状腺新发肿瘤1例，淋巴结转移癌2例，死亡1例，死因为脑血管意外。结论:分化型甲状腺癌的患者行单侧腺叶切除或全甲状腺切除术加颈中央组淋巴结清扫术后不放置引流管是安全和有效的。

Analysis of the safety and feasibility of no drainage after radical thyroidectomy

Objective:To investigate the safety and feasibility of no drainage after radical thyroidectomy.Methods:From September 2013 to July 2019,75 patients without drainage after radical thyroidectomy in our hospital were selected.According to the operation period,it can be divided into three stages.The first stage includes 15 patients who underwent hemithyroidectomy.In the second stage,14 patients were included,including 9 cases of hemithyroidectomy,3 cases of hemithyroidectomy with central neck dissection and 2 cases of total thyroidectomy with central neck dissection.In the third stage,46 patients were included,including 44 cases of hemithyroidectomy or total thyroidectomy with central neck dissection and 2 cases of hemithyroidectomy.The clinicopathological data were collected and followed up.Results:There were 74 cases of differentiated thyroid carcinoma(72 cases of papillary carcinoma,2 cases of follicular carcinoma) and 1 case of medullary carcinoma.The average operation time of the first,second and third stage was (116.67±28.07) min,(129.29±36.31) min and (153.91±35.84) min,the average intraoperative bleeding was (34.33±47.09) mL,(29.29±24.09) mL and (28.70±15.03) mL,and the average time of hospital discharge after operation was (1.80±0.77) days,(2.29±1.64) days and (2.30±1.41) days,respectively.Only the first stage and the third stage had significant difference in the average operation time,and there was no significant difference among the other groups.Postoperative hematoma formation,recurrent laryngeal nerve injury and parathyroid injury occurred in 1(1.3%),2(2.7%) and 30(40.0%) cases respectively.There was no reoperation due to postoperative complications.The patients were followed up for 12~76 months,including 1 case of contralateral thyroid tumor,2 cases of lymph node metastasis and 1 case of death due to cerebrovascular accident.Conclusion:For patients with differentiated thyroid cancer,hemithyroidectomy,total thyroidectomy and central neck dissection,should be safe and effective to choose not to place drainage after operation.