Reexploration for symptomatic hematomas after cervical exploration
Reexploration for symptomatic hematomas after cervical exploration
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DOI：
10.1067/msy.2001.118384
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发表时间：
2001-12-01
期刊：
影响因子：
3.8
通讯作者：
Farley, DR
中科院分区：
文献类型：
--
作者：
Burkey, SH;van Heerden, JA;Farley, DR
背景。需要再次手术的血肿患者占宫颈探查患者的1%。这种并发症对门诊手术的趋势有影响。回顾性分析了该机构（1976年至2000年）13817例接受甲状腺切除术和甲状旁腺切除术的患者，发现42例血肿需要再次手术。病例对照（n = 42）根据年龄、性别、手术类型和年份进行匹配。围手术期危险因素及预后比较。研究组和对照组分别为18名男性和24名女性（平均年龄62岁），接受甲状腺切除术（n = 21）或甲状旁腺切除术（n = 21）。围手术期危险因素组间比较无明显差异。症状包括21例呼吸窘迫，11例疼痛/压力，8例吞咽困难，6例引流。到症状出现的平均时间为17小时（范围：10分钟至5天）。18例术后6小时内出现血肿，16例术后7 ~ 24小时出现血肿，8例术后24小时出现血肿。出血来源为动脉1例，静脉8例，甲状腺/软组织13例，不明来源10例。研究组的平均住院时间更长（7.2天vs 3.6天，P = 0.004）。研究组并发症发生率高于对照组（17例vs 7例，P = 0.03）。没有单一并发症达到显著性：低钙血症（8 vs 3, P = 0.12），伤口感染（3 vs 0, P = 0.87），以及其他（10 vs 5, P = 0.21）。没有任何因素预示这一并发症。(2)高危人群的定义仍然模糊不清。(3)术后6小时以上患者占60%。(4)复诊增加了发病率，延长了住院时间。
Background. Hematomas requiring reoperation affect 1% of patients undergoing cervical exploration. This complication has implications for the trend toward outpatient proceduresMethods. Retrospective review of 13,817 patients undergoing thyroidectomy and parathyroidectomy at this institution (1976 to 2000) identified 42 patients with hematomas requiring reoperation. Case controls (n = 42) were matched for age, gender, and type and year of operation. Perioperative risk factors and outcome were compared..Results. Study and control groups were composed of 18 men and 24 women (mean age, 62 years) undergoing thyroidectomy (n = 21) or parathyroidectomy (n = 21). Comparison of perioperative risk factors yielded no significant difference between groups. Symptoms included respiratory distress in 21 patients, pain/pressure in 11, dysphagia in 8, and drainage in 6. Mean time to symptom onset was 17 hours (range, 10 minutes to 5 days). Eighteen hematomas presented within 6 hours postoperatively, 16 between 7 and 24 hours, and eight beyond 24 hours. The bleeding source was arterial in I patients, venous in 8, thyroid/soft tissue in 13, and indeterminate in 10. Mean hospital stay was longer in the study group (7.2 vs 3.6 days, P = .004). The number of patients with complications was higher in the study group (17 vs 7, P = .03). No single complication reached significance: hypocalcemia (8 vs 3, P = .12), wound infection (3 vs 0, P = .87), and others (10 vs 5, P = .21).Conclusions. (1) No factor foreshadowed this complication. (2) The definition of a high-risk population remains obscure. (3) Sixty percent presented beyond 6 hours postoperatively. (4) Reexploration increased morbidity and lengthened hospital slay.