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Emorragia dopo chirurgia della tiroide: analisi e gestione

Bleeding after thyroidectomy

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  • Published:
L'Endocrinologo Aims and scope

Sommario

Gli studi prospettici sull’incidenza, sull’eziologia e sulla prognosi dei pazienti con emorragia dopo intervento chirurgico alla tiroide sono ancora carenti. Il sanguinamento dopo tiroidectomia non può essere previsto o prevenuto, anche se alcuni fattori di rischio sono noti in ogni singola procedura. Ciò accresce l’importanza della soluzione dei seguenti problemi: 1) meticolosa emostasi e tecnica chirurgica; 2) collaborazione con l’anestesista, ovvero controllo della manovra di Valsalva, pressione sanguigna adeguata al termine dell’operazione e in fase di estubazione; 3) in caso di sanguinamento, una gestione tempestiva, decisiva per il risultato. Ciò richiede un monitoraggio clinico postoperatorio precoce intensivo dei pazienti, idealmente, in sala risveglio monitorati da personale addestrato per almeno 4–6 ore. Il riconoscimento precoce del sanguinamento postoperatorio con conseguente immediato intervento è la chiave per la gestione di questa complicanza.

Abstract

Bleeding after thyroidectomy cannot be predicted or prevented, although some risk factors are known in every procedure. Prospective studies on the incidence, etiology, and prognosis of patients with hemorrhage after thyroid surgery are still lacking. This increases the importance of solving the following problems: a) Meticulous hemostasis and surgical technique; b) Collaboration with the anesthetist, i.e., control of the Valsalva maneuver, adequate blood pressure at the end of the operation and during extubation; c) In case of bleeding, timely management decisive for the result. This requires intensive early postoperative clinical monitoring of patients, ideally in the recovery room monitored by trained personnel for at least 4-6 hours. Early recognition of postoperative bleeding resulting in immediate intervention is the key to managing this complication

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Authors and Affiliations

  1. Divisione di Chirurgia Endocrina, U.O. di Chirurgia Generale, Istituto Auxologico Italiano IRCCS, Milano, Italia

    Antonella Pino, Gianlorenzo Dionigi, Alessandro Matarese, Viola Villardita, Davide Poldi & Francesco Frattini

  2. Dipartimento di Patologia Umana “G. Barresi”, Azienda Ospedaliera G. Martino, Università degli Studi di Messina, Messina, Italia

    Antonella Pino

  3. Dipartimento di Fisiopatologia e dei Trapianti, Università di Milano, Milano, Italia

    Gianlorenzo Dionigi & Francesco Frattini

  4. Dipartimento di Chirurgia Generale e Specialità Chirurgiche, Policlinico Vittorio Emanuele, Università di Catania, Catania, Italia

    Guido Nicola Zanghì

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Correspondence to Antonella Pino.

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Conflitto di interesse

Gli autori Antonella Pino, Gianlorenzo Dionigi, Alessandro Matarese, Viola Villardita, Davide Poldi, Francesco Frattini e Guido Nicola Zanghì dichiarano di non avere conflitti di interesse.

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Pino, A., Dionigi, G., Matarese, A. et al. Emorragia dopo chirurgia della tiroide: analisi e gestione. L'Endocrinologo 24, 13–21 (2023). https://doi.org/10.1007/s40619-023-01204-x

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