Clinical Study About Selective Use Of Drains After Thyroidectomy And Finding The Time Of Safety Extubation

Objective:Choosen patients who would like to have an primary thyroid surgery,we taken the advantage of drainage to test WBC, RBC,chemotactic factors and described the variation tendency about the amount and content of drainage,at the same time,set a control group without drains to evaluate the powerful of reabsorption on wound healed soft tissue after thyroidectomy. Through this,the study would aimto solve the critical problems that how to selective placement drains, to find the time of safety extubation,which can guide the future of fast track surgery study and clinical practice on thyroid disease.Mehtod:A total of 674 patients with clinically thyroid tumor who were admitted to the hospital (The Diagnosis and Treatment Center of Thyroid Diseases, First Affiliated Hospital of Kunming Medical University)from September,2013 to April,2014 were chosen for the prospective study.The patients were randomly divided into eight groups according to extubation time after A(0),B(4),C(8),D(16),E(24)and F(48) hours after operation,G(the test liquid drainage per hour group) and H(analysis of drainage fluid character), I(E+F),with 30 patients for each group. Each case is performed by the doctor on the same treatment group,by using the standard resection of thyroid operation of this treatment center.The volume, character of drainage each time period,the total of liqid,observing bacterial culture and postoperative wound healing were recorded and statistically,at the same time describing drainage fluid properties change trend chart.Results:In the process of the whole experiment,no postoperative hemorrhage and breathing difficulty was found,one was excluded from the experiment because of tube folding.1、The test liquid drainage per hour group:As time gone on,the amount of drainage fluid per hour was gradual decline which into balance about 12 hours after surgery.2、Analysis of drainage fluid character group:As time gone on,the amount of RBC per 4 hours was gradual decline which into balance about 12 hours after surgery;WBC count was largely unchanged.3、Bacterial culture situation about the end of drainage tube:No bacteria was discovered for 24 hours group;3 cases were discovered with positive bacteria of Staphylococcus epidermidis for 48 hours group,there is distinct difference within the groups with P=0.019.4、In 674 patients,1 case was removed out experiment because of drainage tube jam.In the statistical analysis of 673 patients,670 patients were well healed stage I heal without any formation of hematoma in joint cavity;Drainage of incision and tenderness was found in 3 cases,witnout purulent secretion,stage II heal. Drainage of incision leakage was found in 3 cases of 0 hours group after two to three days the removal of tube,the symptom disappeared after 1-2 days of medical treatment;Drainage of incision leakage was found in 4 cases of 4 hours group after one to two days the removal of tube,the symptom disappeared after medical treatment;Drainage of incision leakage was found in 3 cases of 8 hours group after two to three days the removal of tube,the symptom disappeared after medical treatment;Drainage of incision leakage was found in 1 cases of 16 hours group after two days the removal of tube,the symptom disappeared after medical treatment; Drainage of incision leakage was found in 2 cases of 24 hours group after one to two days the removal of tube.the symptom disappeared after medical treatment;Drainage of incision leakage was found in 2 cases of 48 hours group after one to two days the removal of tube,the symptom disappeared after medical treatment;There were 3 cases which were stage II heal, the symptom disappeared after medical treatment;There was no significant difference is compared between six groups P=0.787.Conclusion:The wound fluid of thyroidectomy and the powerful reabsorption ability of the loose connective tissue achieved a balance.It is not necessary to placement drainage for most patients,the remaining patients should be individualized choice.lt is safe to remolve the drainage tube at 12 hours after thyroidectomy,when using drain.By this,It can stimulate the development of fast-track Thyroid Surgery.