Effect of a Polyglycolic Acid Mesh Sheet (Neoveil™) in Thyroid Cancer Surgery: A Prospective Randomized Controlled Trial.
Effect of a Polyglycolic Acid Mesh Sheet (Neoveil™) in Thyroid Cancer Surgery: A Prospective Randomized Controlled Trial.
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甲状腺癌的早期症状有哪些？甲状腺乳头状癌的手术包括甲状腺切除和甲状腺周围淋巴结清扫。淋巴结剥离与剥离区域液体量增加和胸导管损伤引起的乳糜漏有关。聚乙醇酸网片（Neoveil™）已被证明可防止其他手术中的术后液体渗漏。因此，我们旨在评估Neoveil™是否可以减少PTC手术中的术后引流和乳糜漏。使用Neoveil™后，术后第2天引流量显著减少，术后总引流量更低。Neoveil™组的甘油三酯水平较低，但无统计学显著性。在9个月的随访期间，未观察到Neoveil™的不良反应。我们的研究表明，Neoveil™可用于减少PTC甲状腺手术的术后引流。甲状腺癌的早期症状有哪些？PTC的手术包括甲状腺切除和中央淋巴结清扫。中央淋巴结清扫术与清扫区域的液体量增加和胸导管损伤引起的乳糜漏有关。很少有研究涉及甲状腺手术后中央淋巴结清扫减少液体引流和预防乳糜漏。已证明聚乙醇酸网片（Neoveil™）可防止其他手术中的术后液体渗漏。本研究旨在评价聚乙醇酸补片是否可以减少乳头状甲状腺癌手术中的术后引流和乳糜漏，本研究设计为一项在一家大学医院进行的前瞻性、开放标签、随机对照试验。患者被随机分配到仅在中央淋巴结解剖区域使用纤维蛋白胶（对照组）或在纤维蛋白胶后使用聚乙醇酸网片（治疗组）。共入组330例患者，其中5例患者被排除。共161例患者被纳入治疗组，164例患者被纳入对照组。主要结局是Jackson-Pratt引流管的引流量，次要结局是术后第1天和第2天引流液中的甘油三酯水平。术后第2天，治疗组的引流量显著较低（60.9 ± 34.9 mL vs. 72.3 ± 38.0 mL，p = 0.005）。治疗组在整个术后天数（第1天和第2天）的引流量总和也显著较低（142.7 ± 71.0 mL vs. 162.5 ± 71.5 mL，p = 0.013）。治疗组的术后甘油三酯水平较低，但无统计学显著性（术后第1天92.1 ± 60.1 mg/dL vs. 81.3 ± 58.7 mg/dL，p = 0.104;术后第2天67.6 ± 99.2 mg/dL vs. 53.6 ± 80.4 mg/dL，p = 0.162）。术后随访9个月，治疗组未观察到不良反应。我们的研究表明，聚乙醇酸网片可以安全地应用于需要淋巴结清扫的甲状腺切除术患者，以减少术后引流量。
Papillary thyroid cancer (PTC) is the most common type of thyroid cancer. Surgery for PTC involves resection of the thyroid gland and lymph node dissection around thyroid. Lymph node dissection is associated with an increased amount of fluid from the dissection area and chyle leakage due to thoracic duct injury. A polyglycolic acid mesh sheet (Neoveil™) has been proven to prevent postoperative fluid leakage in other surgeries. So, we aim to evaluate whether Neoveil™ can reduce postoperative drainage and chyle leakage in surgery for PTC. With the use of Neoveil™, the amount of drainage significantly decreased on the postoperative 2nd day and postoperative total drainage amount was lower. Triglyceride level was lower in the Neoveil™ group but was not statistically significant. No adverse effect from the Neoveil™ was observed during 9 months follow up. Our study suggests that Neoveil™ can be applied to reduce postoperative drainage in thyroid surgery for PTC. Papillary thyroid cancer (PTC) is the most common type of thyroid cancer. Surgery for PTC involves resection of the thyroid gland and central lymph node dissection. Central lymph node dissection is associated with an increased amount of fluid from the dissection area and chyle leakage due to thoracic duct injury. There are few studies that deal with reducing fluid drainage and preventing chyle leakage after thyroid surgery with central lymph node dissection. A polyglycolic acid mesh sheet (Neoveil™) has been demonstrated to prevent postoperative fluid leakage in other surgeries. This study aims to evaluate whether a polyglycolic acid mesh sheet can reduce postoperative drainage and chyle leakage in papillary thyroid cancer surgery, and this study was designed as a prospective, open-label, randomized controlled trial in a single university hospital. The patients were randomly assigned to having only fibrin glue used in the central node dissection area (control group) or to having a polyglycolic acid mesh sheet applied after fibrin glue (treatment group). A total of 330 patients were enrolled, of which 5 patients were excluded. A total of 161 patients were included in the treatment group, and 164 patients were included in the control group. The primary outcome was the drainage amount from the Jackson-Pratt drain, and the secondary outcome was the triglyceride level in the drained fluid on the 1st and 2nd postoperative days. The drainage amount was significantly lower in the treatment group on the 2nd postoperative day (60.9 ± 34.9 mL vs. 72.3 ± 38.0 mL, p = 0.005). The sum of drainage amount during the whole postoperative days (1st and 2nd days) was also significantly lower in the treatment group (142.7 ± 71.0 mL vs. 162.5 ± 71.5 mL, p = 0.013). The postoperative triglyceride levels were lower in the treatment group but were not statistically significant (92.1 ± 60.1 mg/dL vs. 81.3 ± 58.7 mg/dL on postoperative day 1, p = 0.104 and 67.6 ± 99.2 mg/dL vs. 53.6 ± 80.4 mg/dL on postoperative day 2, p = 0.162). No adverse effects were observed in the treatment groups during the postoperative 9-month follow-up. Our study suggests that polyglycolic acid mesh sheets can be safely applied to reduce postoperative drainage amount in thyroidectomy patients who need lymph node dissection.
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影响因子：
2.5
作者：
Shibuya, Kazuto;Jang, Jin-Young;Fujii, Tsutomu
通讯作者：
Fujii, Tsutomu
影响因子：
44.5
作者：
Miranda-Filho, Adalberto;Lortet-Tieulent, Joannie;Dal Maso, Luigino
通讯作者：
Dal Maso, Luigino
DOI：
10.1016/j.ecl.2018.10.002
发表时间：
2019-03-01
影响因子：
4.5
作者：
Seib, Carolyn Dacey;Sosa, Julie Ann
通讯作者：
Sosa, Julie Ann
影响因子：
2.9
作者：
Satoi, Sohei;Toyokawa, Hideyoshi;Kwon, A-Hon
通讯作者：
Kwon, A-Hon
影响因子：
2.5
作者：
Gonçalves, J;Kowalski, LP
通讯作者：
Kowalski, LP