关键词: 经口腔前庭, 甲状腺手术, 引流

Abstract: Objective To investigate the feasibility and safety of not placing a drainage tube during transoral endoscopic thyroidectomy vestibular approach （TOETVA）. Methods A retrospective analysis was conducted on 416 cases of TOETVA performed at our hospital from August 2021 to April 2024. After exclusions, 386 cases were included and divided into two groups based on the presence or absence of drainage： the no-drainage group （145 cases） and the drainage group （241 cases）. Postoperative hospital stays, pain scores, postoperative bleeding, seroma, and infection rates were compared between the two groups. Results No significant differences were observed in surgery time or postoperative pain scores.Postoperative complications, including bleeding, seroma, infection, hoarseness, and permanent hypoparathyroidism, showed no significant differences between the two groups. The proportion of patients who underwent total thyroidectomy was significantly higher in the drainage group than in the no-drainage group （25/241 vs. 1/145, P=0.01）. Intraoperative predicted bleeding was higher in the drainage group than in the no-drainage group [10（5,10） mL vs. 5（5,5） mL, P<0.01]. Postoperative hospitalization was significantly shorter in the no-drainage group than in the drainage group [2（2,2） vs. 3（2,3） d; P<0.01]. After excluding total thyroidectomy patients, when comparing only unilateral lobectomy cases, significant differences were found in intraoperative blood loss and hospital stay. In the no-drainage group, intraoperative bleeding was less （P<0.001） and postoperative hospitalization was shorter （P<0.001）, while other indicators showed no statistical differences. Conclusion Routine non-drainage in TOETVA is safe and feasible, not increasing the risk of postoperative bleeding, seroma, or infection.

Key words: transoral vestibular approach, thyroid surgery, drainage