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乳腺癌在女性癌症中位居首位,与性成熟期提前、肥胖、不良情绪、生活作息不规律及膳食结构异常等因素有关,患病后无典型症状,部分病人就诊时疾病已发展至中晚期,不利于女性身心健康,甚至危及生命[1]。现今临床主要采取的疗法为手术切除法、内分泌法、放化疗法,又以改良根治术最为关键,但术后受多因素影响,伤口或术区的腔隙内积聚大量液体,出现区域积液,发生皮瓣波动的皮下积液现象等常见的并发症,发生率为6% ~40%,未及时处理可能引起伤口裂开、皮瓣坏死及肩关节活动障碍等。早期探寻影响皮下积液的因素很重要,便于提
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干预组病人引流量、留管时间和住院时间均显著低于对照组(P < 0.01)(见表 1)。
分组 n 引流量/mL 留管时间/d 住院时间/d 干预组 26 353.42±130.86 8.81±1.96 11.77±2.18 对照组 40 511.98±170.38 10.65±2.86 13.10±2.67 t — 4.03 3.10* 2.12 P — < 0.01 < 0.01 < 0.05 *示t′值 表 1 2组5 d引流量、置管时间、住院时间比较(x±s)
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干预组皮下积液发生率11.53%,低于对照组的37.50%(P < 0.05)(见表 2)。
分组 n 皮下积液 切口感染 缺血坏死 干预组 26 3(11.53) 2(7.69) 1(3.85) 对照组 40 15(37.50) 6(15.00) 3(5.00) χ2 — 5.35 0.25* 0.01* P — < 0.05 >0.05 >0.05 *示矫正χ2值 表 2 皮下积液、切口感染、缺血坏死发生率[n;百分率(%)]
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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发生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无统计学意义(P>0.05)(见表 3)。
临床因素 n 积液发生 χ2 P 腋窝淋巴结情况 阳性 15 9(60.00) 5.18 < 0.05 阳性阴性 25 6(24.00) 体质量指数/(kg/m2) < 25 29 10(34.48) 0.08* >0.05 ≥25 11 5(45.45) 合并糖尿病 是 9 7(77.78) 5.97* < 0.05 否 31 8(25.81) 年龄/岁 < 60 33 11(40.00) 0.57* >0.05 ≥60 7 4(16.67) 应用明胶海绵 是 22 5(22.73) 4.55 < 0.05 否 18 10(55.57) *示矫正χ2值 表 3 对照组乳腺癌临床因素与皮下积液发生的关系[n;百分率(%)]
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干预组高危因素病人皮下积液发生率低于对照组(P < 0.05)(见表 4)。
高危因素 干预组 对照组 P 腋窝淋巴结阳性 9.09(1/11) 60.00(9/15) < 0.05* 合并糖尿病 16.67(1/6) 77.78(7/9) < 0.05* 未使用明胶海绵 15.38(2/13) 55.57(10/18) < 0.05* *示Fisher确切概率法 表 4 高危因素病人皮下积液发生率(%)
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
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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。 Abstract:ObjectiveTo 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. MethodsA 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. ResultsThe 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). ConclusionsThe 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. -
Key words:
- breast neoplasms /
- modified radical mastectomy /
- subcutaneous effusion /
- small incision /
- flap fixation
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表 1 2组5 d引流量、置管时间、住院时间比较(x±s)
分组 n 引流量/mL 留管时间/d 住院时间/d 干预组 26 353.42±130.86 8.81±1.96 11.77±2.18 对照组 40 511.98±170.38 10.65±2.86 13.10±2.67 t — 4.03 3.10* 2.12 P — < 0.01 < 0.01 < 0.05 *示t′值 表 2 皮下积液、切口感染、缺血坏死发生率[n;百分率(%)]
分组 n 皮下积液 切口感染 缺血坏死 干预组 26 3(11.53) 2(7.69) 1(3.85) 对照组 40 15(37.50) 6(15.00) 3(5.00) χ2 — 5.35 0.25* 0.01* P — < 0.05 >0.05 >0.05 *示矫正χ2值 表 3 对照组乳腺癌临床因素与皮下积液发生的关系[n;百分率(%)]
临床因素 n 积液发生 χ2 P 腋窝淋巴结情况 阳性 15 9(60.00) 5.18 < 0.05 阳性阴性 25 6(24.00) 体质量指数/(kg/m2) < 25 29 10(34.48) 0.08* >0.05 ≥25 11 5(45.45) 合并糖尿病 是 9 7(77.78) 5.97* < 0.05 否 31 8(25.81) 年龄/岁 < 60 33 11(40.00) 0.57* >0.05 ≥60 7 4(16.67) 应用明胶海绵 是 22 5(22.73) 4.55 < 0.05 否 18 10(55.57) *示矫正χ2值 表 4 高危因素病人皮下积液发生率(%)
高危因素 干预组 对照组 P 腋窝淋巴结阳性 9.09(1/11) 60.00(9/15) < 0.05* 合并糖尿病 16.67(1/6) 77.78(7/9) < 0.05* 未使用明胶海绵 15.38(2/13) 55.57(10/18) < 0.05* *示Fisher确切概率法 -
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