乳腺癌根治术中游离皮瓣时分步电凝对皮瓣愈合的影响  

Influence of fractional electric coagulation on skin flap healing in radical mastectomy

作　　者：周波[1] 聂军[1] 杨卫东[1] 黄烨[1] 

机构地区：[1]宜昌市第一人民医院胸外科,湖北省443002

出　　处：《中华普外科手术学杂志（电子版）》2013年第2期50-52,共3页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

摘　　要：目的探讨在乳腺癌根治术中游离皮瓣时,分步电凝对皮瓣愈合的影响。方法 2008年3月至2010年11月,67例乳腺癌的根治手术中,采用分步电凝法游离皮瓣(实验组),即游离肿瘤周围薄皮瓣时使用电刀的低档位低电流,游离外周厚皮瓣时使用电刀的中档位中电流。将该组患者皮瓣的愈合情况与2003年1月至2009年9月间常规电刀游离(对照Ⅰ组)、手术刀游离(对照Ⅱ组)的皮瓣愈合情况进行比较。结果 67例乳腺癌根治术采用分步电凝法游离皮瓣的患者(实验组)中有5例发生皮瓣坏死,坏死发生率为7.46%;对照Ⅰ组坏死发生率为35.92%(37/103);对照Ⅱ组坏死发生率为30.51%(18/59)。实验组与对照Ⅰ、Ⅱ组的皮瓣坏死率差异有显著统计学意义,(χ2=17.675,χ2=11.166),P<0.01。所有患者随访5～60个月,除对照Ⅰ组中1例炎性乳癌患者于术后7个月局部复发外,其余患者均无局部复发。结论乳腺癌根治手术中采用分步电凝法可明显降低皮瓣坏死的发生率。Objective To investigate the influence of fractional electric coagulation on skin flap healing in dissection of radical mastectomy. Methods Fractional electric coagulation was used to dissect skin flap in 67 patients, who received radical mastectomy （ experimental group）. Briefly, an electric knife with a low-grade low current was used to dissect the thin skin flap around a tumor, while an electric knife with a middle-grade middle current was used to dissect the thick skin flap peripherally. These patients were operated on in our hospital from March 2008 to November 2010. An conventional electric knife was used in control group ｜ and an operating knife was used in control group ]] from January 2003 to September 2009. The skin healing of patients in the 3 groups were compared. Results In 67 patients treated by using fractional electric coagulation, 5 patients （7.46%） had skin flap necrosis. The incidence rate of skin flap necrosis was 35.92% （37/103） in the control group I ,and 30.51% （18/59） in the control group l]. There was significant difference in skin flap necrosis rate in the experimental group, control group I and control group l] （X2 = 17. 675, X2 = 11. 166） , P 〈0.01. All patients were followed up for 5 - 60 months. Only 1 patient with inflammatory breast cancer suffered from local recurrence 7 months after operation in the control group ｜ . Conclusion Fractional electric coagulation in radical mastectomy could decrease the incidence rate of skin flap necrosis significantly.

关 键 词：乳腺肿瘤 乳房切除术 根治性 外科皮瓣 

分 类 号：R737.9[医药卫生—肿瘤]