갑상선절제술 후 혈종의 임상 양상
Clinical Features of Post-thyroidectomy Hematoma
정소영, 김형일, 윤종호, 남기현, 장항석, 박정수,
소속 상세정보
정소영 ( Jung So-Young )
한림대학교 의과대학 강동성심병원 외과학교실
김형일 ( Kim Hyung-Il )
연세대학교 의과대학 외과학교실
윤종호 ( Yoon Jong-Ho )
한림대학교 의과대학 강동성심병원 외과학교실
남기현 ( Nam Kee-Hyun )
연세대학교 의과대학 외과학교실
장항석 ( Chang Hang-Seok )
연세대학교 의과대학 외과학교실
박정수 ( Park Cheong-Soo )
연세대학교 의과대학 외과학교실
KMID : 0371320040670040286
Abstract
PURPOSE: A post-thyroidectomy hematoma is a rare complication, affecting 0.1~2.5% of patients undergoing a thyroidectomy, but this complication deserves special attention because it is potentially life threatening and unpredictable. This study was performed to evaluate the prevalence and clinical features of post-thyroidectomy hematomas as well as their implications on the early discharge after a thyroidectomy.
METHODS: In a retrospective review of 5,465 patients that underwent a thyroidectomy between Jan 1994 and Dec 2003, 21 (0.38%) with post-thyroidectomy hematomas were identified. The clinical features and outcomes of these 21 patients were evaluated.
RESULTS: The 21 patients were composed of 3 men and 18 women, with a mean age of 47.9+/-19.4 years, ranging from 23~80. The mean time to recognition of the hematoma was 7.0+/-15.3 hours, ranging from 0~72. Sixteen hematomas (76.2%) presented within 6 hours postoperatively, 4 (19.0%) between 6 and 24 hours, and 1 (4.8%) after more than 24 hours. Except for two patients with minimal hematomas, the other 19 underwent re-exploration under general anesthesia after evacuation of the hematoma at bedside. The bleeding source was the lacerated strap muscles in 16 patients (76.2%), venous in 3, arterial in 1 and thyroid lobe stump in 1. Mean hospital stay was 5.2+/-2.0 days, ranging from 2~9. There were no mortality or complications after reoperation, and patients required a blood transfusion or tracheostomy. There were no significant differences in the clinical features between Graves’ disease and non-Graves’ disease, as well as between benign and malignant groups.
CONCLUSION: Early detection and prompt surgical intervention are critical to a successful outcome in patients with post- thyroidectomy hematomas. Because most of the patients in our series with post-thyroidectomy hematomas presented within 24 hours postoperatively, early discharge, with careful monitoring for the first 24 hours after a thyroidectomy, can be recommended. However the relatively long interval between the initial operation and the development of the hematoma should be considered when recommending early discharge after a thyroidectomy.
키워드
갑상선절제술; 합병증; 혈종; Thyroidectomy; Complication; Hematoma
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