Risk factors and bleeding points for hemorrhage after thyroidectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

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;

Corresponding author：

ZHU Jingqiang, Email: zjq-wkys@163.com

Keywords：

thyroidectomy; postoperative hemorrhage; bleeding point; risk factor

DOI：

10.7507/1007-9424.201905109

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

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.

Citation： LI Zhe, ZHANG Lingyun, LEI Jianyong, FEI Yuan, XING Zhichao, ZHU Jingqiang. Risk factors and bleeding points for hemorrhage after thyroidectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(12): 1429-1433. doi: 10.7507/1007-9424.201905109 Copy

1.	Mao Y, Xing M. Recent incidences and differential trends of thyroid cancer in the USA. Endocr Relat Cancer, 2016, 23(4): 313-322.
2.	Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
3.	郑荣寿, 孙可欣, 张思维, 等. 2015 年中国恶性肿瘤流行情况分析. 中华肿瘤杂志, 2019, 41(1): 19-28.
4.	陈万青, 李贺, 孙可欣, 等. 2014 年中国恶性肿瘤发病和死亡分析. 中华肿瘤杂志, 2018, 40(1): 5-13.
5.	殷德涛, 李香华, 李红强, 等. 甲状腺术后出血的原因及处理: 附 8 例临床分析. 中国普通外科杂志, 2015, 24(11): 1592-1595.
6.	Farooq MS, Nouraei R, Kaddour H, et al. Patterns, timing and consequences of post-thyroidectomy haemorrhage. Ann R Coll Surg Engl, 2017, 99(1): 60-62.
7.	Ishikawa M, Namizato D, Sakamoto A. The value of acoustic respiratory rate monitoring in a patient with postoperative hemorrhage after thyroidectomy: a case report. J Clin Monit Comput, 2019, [Epub ahead of print].
8.	Narayanan S, Arumugam D, Mennona S, et al. An evaluation of postoperative complications and cost after short-stay thyroid operations. Ann Surg Oncol, 2016, 23(5): 1440-1445.
9.	Suzuki S, Yasunaga H, Matsui H, et al. Factors associated with neck hematoma after thyroidectomy: a retrospective analysis using a Japanese Inpatient Database. Medicine (Baltimore), 2016, 95(7): e2812.
10.	Dehal A, Abbas A, Hussain F, et al. Risk factors for neck hematoma after thyroid or parathyroid surgery: ten-year analysis of the nationwide inpatient sample database. Perm J, 2015, 19(1): 22-28.
11.	Oltmann SC, Alhefdhi AY, Rajaei MH, et al. Antiplatelet and anticoagulant medications significantly increase the risk of postoperative hematoma: review of over 4 500 thyroid and parathyroid procedures. Ann Surg Oncol, 2016, 23(9): 2874-2882.
12.	Perera M, Anabell L, Page D, et al. Risk factors for post-thyroidectomy haematoma. J Laryngol Otol, 2016, 130 Suppl 1: S20-S25.
13.	Weiss A, Lee KC, Brumund KT, et al. Risk factors for hematoma after thyroidectomy: results from the nationwide inpatient sample. Surgery, 2014, 156(2): 399-404.
14.	Chen E, Cai Y, Li Q, et al. Risk factors target in patients with post-thyroidectomy bleeding. Int J Clin Exp Med, 2014, 7(7): 1837-1844.
15.	Xie QP, Xiang C, Wang Y, et al. The patterns and treatment of postoperative hemorrhage and hematoma in total endoscopic thyroidectomy via breast approach: experience of 1 932 cases. Endocrine, 2019, 63(3): 422-429.
16.	Liu J, Sun W, Dong W, et al. Risk factors for post-thyroidectomy haemorrhage: a meta-analysis. Eur J Endocrinol, 2017, 176(5): 591-602.
17.	金纯, 刘乐, 陈恩东, 等. 甲状腺手术术后出血因素分析. 中国农村卫生事业管理, 2015, 35(5): 664-666.
18.	陈润成, 梁柳森, 张继红. 甲状腺手术后出血紧急处理与预防. 现代临床医学生物工程学杂志, 2000, 6(2): 51.
19.	Liu J, Li Z, Liu S, et al. Risk factors for and occurrence of postoperative cervical hematoma after thyroid surgery: a single-institution study based on 5 156 cases from the past 2 years. Head Neck, 2016, 38(2): 216-219.
20.	龙淼云, 黎洪浩, 林俊双, 等. 甲状腺术后出血的位置及原因分析. 临床外科杂志, 2013, 21(2): 113-115.
21.	Zhang X, Du W, Fang Q. Risk factors for postoperative haemorrhage after total thyroidectomy: clinical results based on2, 678 patients. Sci Rep, 2017, 7(1): 7075.
22.	Godballe C, Madsen AR, Pedersen HB, et al. Post-thyroidectomy hemorrhage: a national study of patients treated at the Danish departments of ENT Head and Neck Surgery. Eur Arch Otorhinolaryngol, 2009, 266(12): 1945-1952.
23.	张艳, 罗渝昆, 杨明, 等. 甲状腺富血供病灶的超声造影诊断价值. 中华医学超声杂志: 电子版, 2017, 14(7): 532-537.
24.	Ozdemir M, Makay O, Icoz G, et al. What adds Valsalva maneuver to hemostasis after Trendelenburg’s positioning during thyroid surgery? Gland Surg, 2017, 6(5): 433-436.
25.	Moumoulidis I, Martinez Del Pero M, Brennan L, et al. Haemostasis in head and neck surgical procedures: Valsalva manoeuvre versus Trendelenburg tilt. Ann R Coll Surg Engl, 2010, 92(4): 292-294.
26.	Tokaç M, Dumlu EG, Bozkurt B, et al. Effect of intraoperative valsalva maneuver application on bleeding point detection and postoperative drainage after thyroidectomy surgeries. Int Surg, 2015, 100(6): 994-998.

1. Mao Y, Xing M. Recent incidences and differential trends of thyroid cancer in the USA. Endocr Relat Cancer, 2016, 23(4): 313-322.
2. Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
3. 郑荣寿, 孙可欣, 张思维, 等. 2015 年中国恶性肿瘤流行情况分析. 中华肿瘤杂志, 2019, 41(1): 19-28.
4. 陈万青, 李贺, 孙可欣, 等. 2014 年中国恶性肿瘤发病和死亡分析. 中华肿瘤杂志, 2018, 40(1): 5-13.
5. 殷德涛, 李香华, 李红强, 等. 甲状腺术后出血的原因及处理: 附 8 例临床分析. 中国普通外科杂志, 2015, 24(11): 1592-1595.
6. Farooq MS, Nouraei R, Kaddour H, et al. Patterns, timing and consequences of post-thyroidectomy haemorrhage. Ann R Coll Surg Engl, 2017, 99(1): 60-62.
7. Ishikawa M, Namizato D, Sakamoto A. The value of acoustic respiratory rate monitoring in a patient with postoperative hemorrhage after thyroidectomy: a case report. J Clin Monit Comput, 2019, [Epub ahead of print].
8. Narayanan S, Arumugam D, Mennona S, et al. An evaluation of postoperative complications and cost after short-stay thyroid operations. Ann Surg Oncol, 2016, 23(5): 1440-1445.
9. Suzuki S, Yasunaga H, Matsui H, et al. Factors associated with neck hematoma after thyroidectomy: a retrospective analysis using a Japanese Inpatient Database. Medicine (Baltimore), 2016, 95(7): e2812.
10. Dehal A, Abbas A, Hussain F, et al. Risk factors for neck hematoma after thyroid or parathyroid surgery: ten-year analysis of the nationwide inpatient sample database. Perm J, 2015, 19(1): 22-28.
11. Oltmann SC, Alhefdhi AY, Rajaei MH, et al. Antiplatelet and anticoagulant medications significantly increase the risk of postoperative hematoma: review of over 4 500 thyroid and parathyroid procedures. Ann Surg Oncol, 2016, 23(9): 2874-2882.
12. Perera M, Anabell L, Page D, et al. Risk factors for post-thyroidectomy haematoma. J Laryngol Otol, 2016, 130 Suppl 1: S20-S25.
13. Weiss A, Lee KC, Brumund KT, et al. Risk factors for hematoma after thyroidectomy: results from the nationwide inpatient sample. Surgery, 2014, 156(2): 399-404.
14. Chen E, Cai Y, Li Q, et al. Risk factors target in patients with post-thyroidectomy bleeding. Int J Clin Exp Med, 2014, 7(7): 1837-1844.
15. Xie QP, Xiang C, Wang Y, et al. The patterns and treatment of postoperative hemorrhage and hematoma in total endoscopic thyroidectomy via breast approach: experience of 1 932 cases. Endocrine, 2019, 63(3): 422-429.
16. Liu J, Sun W, Dong W, et al. Risk factors for post-thyroidectomy haemorrhage: a meta-analysis. Eur J Endocrinol, 2017, 176(5): 591-602.
17. 金纯, 刘乐, 陈恩东, 等. 甲状腺手术术后出血因素分析. 中国农村卫生事业管理, 2015, 35(5): 664-666.
18. 陈润成, 梁柳森, 张继红. 甲状腺手术后出血紧急处理与预防. 现代临床医学生物工程学杂志, 2000, 6(2): 51.
19. Liu J, Li Z, Liu S, et al. Risk factors for and occurrence of postoperative cervical hematoma after thyroid surgery: a single-institution study based on 5 156 cases from the past 2 years. Head Neck, 2016, 38(2): 216-219.
20. 龙淼云, 黎洪浩, 林俊双, 等. 甲状腺术后出血的位置及原因分析. 临床外科杂志, 2013, 21(2): 113-115.
21. Zhang X, Du W, Fang Q. Risk factors for postoperative haemorrhage after total thyroidectomy: clinical results based on2, 678 patients. Sci Rep, 2017, 7(1): 7075.
22. Godballe C, Madsen AR, Pedersen HB, et al. Post-thyroidectomy hemorrhage: a national study of patients treated at the Danish departments of ENT Head and Neck Surgery. Eur Arch Otorhinolaryngol, 2009, 266(12): 1945-1952.
23. 张艳, 罗渝昆, 杨明, 等. 甲状腺富血供病灶的超声造影诊断价值. 中华医学超声杂志: 电子版, 2017, 14(7): 532-537.
24. Ozdemir M, Makay O, Icoz G, et al. What adds Valsalva maneuver to hemostasis after Trendelenburg’s positioning during thyroid surgery? Gland Surg, 2017, 6(5): 433-436.
25. Moumoulidis I, Martinez Del Pero M, Brennan L, et al. Haemostasis in head and neck surgical procedures: Valsalva manoeuvre versus Trendelenburg tilt. Ann R Coll Surg Engl, 2010, 92(4): 292-294.
26. Tokaç M, Dumlu EG, Bozkurt B, et al. Effect of intraoperative valsalva maneuver application on bleeding point detection and postoperative drainage after thyroidectomy surgeries. Int Surg, 2015, 100(6): 994-998.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Risk factors and bleeding points for hemorrhage after thyroidectomy

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content