腋下多点皮瓣固定及胸壁小切口减张改善乳腺癌改良根治术后皮下积液的有效性及安全性研究  

Study on the efficacy and safety of multi-point axillary flap fixation and small incision reduction of chest wall in the improvement of subcutaneous hydrops after modified radical mastectomy

作　　者：伍铜锤 尹小强 杨武林 郭兵 WU Tong-chui;YIN Xiao-qiang;YANG Wu-lin;GUO Bing(Department of Thyroid and Breast Surgery,Hefei Cancer Hospital,Chinese Academy of Sciences,Hefei Anhui 230000;Medical Physics Center,Hefei Institute of Material Research,Chinese Academy of Sciences,Hefei Anhui 230000,China)

机构地区：[1]中国科学院合肥肿瘤医院甲乳外科,安徽合肥230000 [2]中国科学院合肥物质研究院医学物理中心,安徽合肥230000

出　　处：《蚌埠医学院学报》2020年第8期993-996,共4页Journal of Bengbu Medical College

基　　金：国家自然科学基金资助项目(81872276)。

摘　　要：目的:探讨乳腺癌改良根治术中应用腋下多点皮瓣固定及胸壁小切口减张改善术后皮下积液的有效性及安全性,并对皮下积液相关致因进行分析。方法:收集66例乳腺癌改良根治术病人,根据手术方式的不同,分为对照组(n=40)和干预组(n=26)。对照组行常规腋窝淋巴结清扫,留置腋窝、胸壁2根引流管;干预组除了对照组所行治疗,增加缝合固定腋窝处皮瓣和胸壁,创缘两侧皮肤做减张性小切口。比较2组病人置管时间、住院时间及皮下积液等指标。结果:干预组病人引流量、留管时间、住院时间、皮下积液发生率及高危因素病人皮下积液发生率均显著低于对照组(P<0.05~P<0.01)。对照组不同腋窝淋巴结情况、是否合并糖尿病的因素、是否应用明胶海绵术后皮下积液发生率差异均有统计学意义(P<0.05);不同年龄段和体质量指数术后发生皮下积液发生率差异均无统计学意义(P>0.05)。结论:乳腺癌改良根治术后发生皮下积液的因素包括腋窝淋巴结阳性、是否合并糖尿病及是否应用明胶海绵。改进手术方式对减少腋窝、胸壁皮下积液具有重要的意义。Objective:To investigate the effectiveness and safety of multi-point axillary flap fixation and small incision reduction of chest wall in the improvement of subcutaneous hydrops after modified radical mastectomy,and analyze the related risk factors of subcutaneous effusion.Methods:A total of 66 patients treated with modified radical mastectomy were divided into the control group(n=40)and intervention group(n=26)according to the surgical methods.The control group was treated with the routine axillary lymph node dissection combined with retained two drainage tubes in the axillary and chest wall.The intervention group was treated with strengthening the suturing and fixing the axillary skin flap with chest wall combined with subtensive incision on both sides of the border on the basis of the control group.The time of catheterization,length of stay and subcutaneous effusion were compared between two groups.Results:The volume of drainage,indwelling catheter time,length of stay and incidence rate of subcutaneous hydrops in intervention group were significantly lower than those in control group(P<0.05 to P<0.01).In the control group,the differences of the incidence rates of subcutaneous hydrops in patients with different axillary lymph nodes,diabetes mellitus and gelfoam application were statistically significant(P<0.05).After surgery,there was no statistical significance in the incidence rate of subcutaneous hydrops in different age and body mass index in control group(P>0.05).Conclusions:The positive axillary lymph nodes,diabetes mellitus and gelatin spongee use are the influencing factors of subcutaneous hydrops.The improved surgical method is of great significance to reduce subcutaneous effusion in axillary and chest wall.

关 键 词：乳腺肿瘤 改良根治术 皮下积液 小切口 皮瓣固定 

分 类 号：R737.9[医药卫生—肿瘤]