摘要
目的探讨甲状腺术后出血的危险因素及常见出血部位,为预防术后出血提供临床依据。方法回顾性分析2010年11月至2017年11月期间四川大学华西医院的21例甲状腺术后出血和63例非出血患者的临床资料,探索术后出血的影响因素。结果单因素分析结果显示,合并高血压、肿瘤最大径、淋巴结转移、喉返神经浸润、T分期、N分期、甘油三酯和血清高密度脂蛋白(high density lipoprotein,HDL)水平与术后出血有关(P<0.05);多因素分析结果显示,淋巴结转移(OR=16.219,P=0.002)和血清HDL水平(OR=0.035,P=0.006)为术后出血的影响因素。术后出血的患者中,最常见的5个出血部位依次为:带状肌及胸锁乳突肌(均占19.2%)、食管气管表面血管(11.5%)、甲状腺床(7.7%)及喉返神经旁小血管(7.7%)。结论淋巴结转移和低血清HDL水平为甲状腺术后出血的危险因素。术后出血的好发部位主要为颈部肌肉。
Objective To explore the risk factors and bleeding points associated with postoperative hemorrhage after thyroidectomy and provide clinical basis for prevention of postoperative bleeding.Methods The clinical data of 21 patients with postoperative hemorrhage and 63 patients without postoperative hemorrhage who underwent thyroidectomy from Nov.2010 to Nov.2017 in West China Hospital were retrospectively analyzed.Results Univariate analysis showed that hypertension,maximum tumour dimension,lymph node metastasis,recurrent laryngeal nerval infiltration,T stage,N stage,serum triglyceride,and serum high density lipoprotein were significantly associated with postoperative hemorrhage(P<0.05).Multivariate analysis showed that lymph node metastasis(OR=16.219,P=0.002)and low serum high density lipoprotein(OR=0.035,P=0.006)were risk factors for postoperative hemorrhage.Among the patients with postoperative bleeding,the most common five bleeding sites were:ribbon muscle and sternocleidomastoid muscle(both was 19.2%),esophageal tracheal surface blood vessels(11.5%),thyroid bed(7.7%),and larynx recurrent paravascular small vessels(7.7%).Conclusions Lymph node metastasis and serum HDL are independent risk factors of hemorrhage after thyroidectomy.The predilection site for postoperative bleeding is mainly the neck muscle.
作者
厉喆
张龄允
雷建勇
费媛
邢志超
朱精强
LI Zhe;ZHANG Lingyun;LEI Jianyong;FEI Yuan;XING Zhichao;ZHU Jingqiang(Department of Thyroid&Parathyroid Surgery Center,West China Hospital,Sichuan University,Chengdu 610041,P.R.China)
出处
《中国普外基础与临床杂志》
CAS
2019年第12期1429-1433,共5页
Chinese Journal of Bases and Clinics In General Surgery
关键词
甲状腺手术
术后出血
出血部位
危险因素
thyroidectomy
postoperative hemorrhage
bleeding point
risk factor
