褥式减张预防乳腺癌根治术后皮瓣坏死

Horizontal mattress suture without tension prevents necrosis of incisal margin after radical mastectomy

目的 探讨褥式减张缝合降低乳腺癌根治术后皮瓣切缘坏死的发生。方法 对65例乳腺癌根治术患者采用褥式减张缝合减少切缘张力,结合闭式引流和加压包扎。同期根治术患者306例采用闭式引流和加压包扎作为对照。统计住院期间手术切缘皮瓣缺血和感染表现。结果 切缘皮肤花斑3.08% vs 7.52％(P=0.157),切缘皮肤表皮松解1.54% vs 5.88%(P=0.101),干性坏死1.54％ vs 11.77%(P=0.003),切缘皮肤化脓性感染0 vs 5.56％(P=0.009),皮瓣切缘一期愈合率96.92％vs 80.72%(P=0.001)。结论 乳腺癌根治术后皮瓣坏死和继发感染并不少见,褥式减张缝合方法简便、效果可靠,可明显改善切口愈合,预防皮瓣切缘缺血坏死和继发感染。

Objective To discuss how horizontal mattress suture (HMS) may reduce necrosis of incisal margin after radical mastectomy(RM). Methods From Jan 1999 to Jun 2003, 65 patients underwent RM, which were sutured up with nylon stitches by HMS procedure to reduce incision tension, with bandaging up and closed drainage, the other 306 cases as controls were sutured by routine, also with bandaging up and closed drainage. We sumed up the manifestations of ischemia of the incisal site and infection at hospitalization. Results The rate of 'Flower Patches' presented near the margin was 3. 08% vs 1. 52% (P =0.157) , epidermolysis 1. 54% vs 5. 88% (P = 0. 101) , dryed margin necrosis 1.54% vs 11.77% (P =0.003) , pyogenic infection 0 vs 5.56%(P =0.009), primary incision cure 96.92% vs 80.72% (P =0.001). Conclusion Margin necrosis and secondary infection are common in patients undergoing radical mastectomy. Horizontal mattress suturing provides a simple procedure to prevent ischemia of the skin flap, and shortens prolonged hospitolization.