PRACTICAL MANAGEMENT OF POST-THYROIDECTOMY HEMATOMA
PRACTICAL MANAGEMENT OF POST-THYROIDECTOMY HEMATOMA
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DOI：
10.1002/jso.2930570406
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发表时间：
1994-12-01
影响因子：
2.5
通讯作者：
JAFFE, BM
中科院分区：
文献类型：
--
作者：
SHAHA, AR;JAFFE, BM
甲状腺疾病和甲状腺肿瘤手术都很常见。甲状腺切除术的几种并发症是众所周知的。其中一些是相当令人不安的，如喉返神经损伤和永久性甲状旁腺功能减退。然而，术后血肿往往在恢复室可能是致命的。甲状腺切除术后的密切观察和早期干预是非常必要的。在一系列的600甲状腺切除术进行了11年的时间，8名患者术后血肿。其中7例患者接受了再次探查，1例患者接受了保守治疗。2例患者因血肿再积聚进行了第二次再探查。除一名老年患者因肺储备差而需要通气支持外，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，她也恢复良好。1例患者在术后24小时内再次探查血肿，其余患者在初次手术后4-6小时内再次探查。由于喉和咽壁水肿的程度，由资深、有经验的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，必须准备好紧急插管。我们建议所有发生术后血肿的患者，在甲状腺切除术后密切观察恢复室，并早期探查和清除血肿。对于选定的血肿最小且无进展的患者，可考虑采用保守方法。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最小化，使甲状腺切除术成为一种更安全的手术和手术的成功。(C)1994 Wiley-Liss，Inc.
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. (C) 1994 Wiley-Liss, Inc.