初次甲状腺术后是否放置引流及其安全拔除的临床研究

发布时间：2018-07-12 11:04

本文选题：甲状腺外科 + 引流术　；参考：《昆明医科大学》2015年硕士论文

【摘要】：[目的]选择拟行初次甲状腺开放手术的病例为研究对象,通过对术后引流量及其红细胞、白细胞和引流管末端细菌培养等相关指标的测定,构建初次甲状腺术后引流液量的变化趋势图及白细胞等感染因子的变化规律图,并进一步通过不同拔管时间对切口愈合的影响,临床验证甲状腺术后病人创面软组织的强大重吸收能力,选择是否常规放置引流管及引流管的安全拔出时间,为甲状腺疾病快速康复医学的临床研究及实践提供参考。[方法]收集2013年9月-2014年4月间在昆明医科大学第一附属医院甲状腺疾病诊治中心拟行开放性甲状腺切除术,符合入组标准的674例患者进行前瞻性研究分析,随机分为A(0h不放置引流管组)、B (4h)、C (8h)、D (16h)、E (24h)、F (48h)拔管组、G(测每小时引流液)、H(分析引流液性状),I(引流管末端送培养E+F)组,每组病例均大于30例,各组病例手术均由同一治疗组医师进行,依据最新的ATA指南,采用该治疗中心标准甲状腺切除术式。记录术后各个时间段引流量、术后各组总引流量及分析时间段引流液性状,观察细菌培养情况及术后切口愈合情况,所得数据进行统计分析,对比各组有无差异,及描绘引流液性状变化趋势图。[结果]：整个研究过程中,未出现术后出血和呼吸困难并发症,有1例因引流管堵塞排除实验。1、测每小时引流液组：提出小时引流液及时间段引流液的概念,随着时间推移,小时引流液的量逐渐下降,约在术后12小时甲状腺术后的病人引流液引出量趋于平稳;2、分析引流液性状变化规律组：随着时间延长,约在术后12小时甲状腺术后病人引流液中红细胞计数降低速度趋于平稳；白细胞计数在4小时达高峰,之后大体不变。3、引流管末端的细菌培养情况：末端在24小时拔出组未见细菌生长,48小时组可见3例培养出细菌,结果为表皮葡萄球菌(+),组间比较有差异,存在统计学意义,P=0.019。4、各时间段拔出引流管组切口愈合情况：674例患者中,1例因引流管堵塞排除实验,进入统计的673例患者中,有670例患者的切口全部甲级愈合,有3例乙级愈合。甲级愈合患者中均无创面血肿形成,其中15例引流管口外渗液,经积极外科换药后,全部愈合：0h组中有3例在术后2-3天内出现皮下积液,持续1-2天,经外科换药后消失；4h组有4例在拔出引流管后1-2天内引流口出现外渗积液,经换药后,此症状逐渐消失；8h组有3例在拔出引流管后2-3天内引流口出现外渗积液,经换药后,此症状逐渐消失；16h组有1例在拔出引流管后2天引流口出现外渗积液,经换药后,此症状逐渐消失；24h组有2例在拔出引流管后1-2天内引流口出现外渗积液,经换药后,此症状逐渐消失；48h组有2例在拔出引流管后1-2天内引流口出现外渗积液,经换药后,此症状逐渐消失；3例乙级愈合病例,经换药后症状消失,切口愈合。六组间比较差异无统计学意义,P=-0.787。[结论]：甲状腺创面疏松软组织具有的强大重吸收功能,可以与创面渗出速度相平衡,大部分病例术后不放置引流管是安全的,剩余病例应个体化选择性留置引流管。若放置引流管,术后12小时是安全拔管时间,促进甲状腺外科快速康复的发展。
[Abstract]:[Objective] to choose the case of first open thyroid surgery as the research object. Through the determination of the related indexes of postoperative flow rate, red blood cell, leukocyte and drainage tube end bacteria culture, the trend map of the change of drainage volume and the change pattern of leukocyte infection factors after primary thyroid operation were constructed, and further pass through The effect of different extubation time on the healing of the incision, the strong reabsorption ability of the soft tissue in the patients after thyroid surgery, the selection of the regular placement of drainage tube and the safe pulling time of the drainage tube, provide reference for the clinical study and practice of the rapid rehabilitation medicine for thyroid disease. [Methods] collect the April -2014 year in September 2013. Open thyroidectomy was planned to be performed at the First Affiliated Hospital of Kunming Medical University. 674 patients who were in accordance with the criteria were randomly divided into A (0h without drainage tube group), B (4h), C (8h), D (16h), E (24h), F (48h) extubation group. The end of the flow tube was sent to the E+F group. Each case was more than 30 cases. All the cases were performed by the same treatment group. According to the latest ATA guide, the standard thyroidectomy was used in the treatment center. The flow rate of each time after the operation was recorded, the total flow rate of each group and the characteristics of the drainage fluid were analyzed, and the culture condition of the bacteria was observed. Status and postoperative wound healing, statistical analysis of the data, compared with each group, and depicting the trend map of the characteristics of the drainage. [results] there were no postoperative complications of bleeding and dyspnea during the whole study. 1 cases were excluded from the experimental.1 due to drainage tube blockage, and the hourly drainage group was measured, and the hourly drainage fluid was put forward. The concept of the drainage fluid in the time period, the amount of the drainage fluid decreased gradually with time, about 12 hours after the operation of the patients after the thyroidectomy, the drainage volume of the drainage fluid tended to be stable; 2, the analysis of the variation of the characteristics of the drainage fluid: with the time prolonging, the erythrocyte count decreased in the drainage fluid after the operation 12 hours after the operation. The white blood cell count reached the peak at 4 hours, after which the bacteria culture at the end of the drainage tube was unchanged by.3, and the bacteria culture at the end of the drainage tube was not seen in the 24 hour group. In the 48 hour group, the bacteria were found in 3 cases. The result was that the Staphylococcus epidermidis (+) was different between the groups. There was statistical significance, P=0.019.4, drawing out drainage in each time period. Of the 674 patients, 1 of the 674 cases were excluded because of drainage tube blockage. Among the 673 patients who entered the statistics, all of the 670 patients were healed with grade A and 3 cases of grade B healing. There were no wound hematoma in the patients with grade a healing, of which 15 cases were healed after positive surgical replacement, and all healed in group 0h. There were 3 cases of subcutaneous effusion in 2-3 days after the operation, which lasted for 1-2 days and disappeared after surgical dressing. 4 cases in group 4H had exudate effusion within 1-2 days after pulling out the drainage tube. After changing the medicine, the symptoms disappeared gradually, and 3 cases in group 8h had the drainage and exudate effusion within 2-3 days after pulling out the drainage tube, and the symptom disappeared gradually after changing the medicine. 1 In group 6h, 1 cases had exudate effusion in the drainage mouth 2 days after pulling out the drainage tube. After changing the medicine, the symptoms disappeared gradually. In group 24h, 2 cases had exudate effusion in the drainage mouth within 1-2 days after pulling out the drainage tube. After changing the medicine, the symptoms disappeared gradually. In group 48h, the drainage mouth appeared exudate effusion within 1-2 days after pulling out the drainage tube, and after changing the medicine, the drug was changed. The symptoms gradually disappeared; 3 cases of second grade healing, the symptoms disappeared and the incision healed. There was no statistical difference between the six groups. P=-0.787.[conclusion: the strong reabsorption function of the loose soft tissue of the thyroid wound is balanced with the exudation speed of the wound, and the rest of the large cases is safe without placing the drainage tube after operation. Cases should be individualized and indwelling drainage tube. If the drainage tube is placed, the safe extubation time should be 12 hours after operation, so as to promote the rapid recovery of thyroid surgery.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R653

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