不同包扎引流方法对乳腺癌改良根治术后皮下积液的影响

Study on the effect of pressure dressings and drainage on seroma formation following modified radical mastectomy.

目的 探讨乳腺癌改良根治术后伤口加压包扎及引流对皮下积液的影响。方法 将70例病人随机分组：A组，采用伤口普通包扎加一次性负压引流器引流；B组，适当压力包扎加一次性负压引流器引流：C组，适当压力包扎+持续低负压吸引(C_1组压力为13.3Pa、C_2组压力为26.7Pa)三种方法行创口负压引流。结果24h引流量B组(140±33.4)大于A组(116.5±23.2)(P＝0.014)，C组(167±27.1)大于B组(140±33.4)(P=0.003)，C_1组(162±25.4)与C2组(172±28.6)相似(P＝0.320)；引流总量B组(389.5±38.7)＜A组(423±45.1)(P＝0.016)，C组(346±38.6)＜B组(389.5±38.7)(P＝0.000)，C_1组(351.3±44.4)与C_2组(340.7±32.6)相似(P=0.459)；拔管时间B组(8.2±2.2)＜A组(10.1±2.7)(P＝0.017)，C组(6.4±1.5)＜B组(8.2±2.2)(P＝0.002)，C_1组(6.3±1.4)与C_2组(6.6±1.6)相似(P=0.552)；皮下积液发生率B组30％＜A组65％(P＝0.027)，C组6.7％＜B组30％(P＝0.027)，C_1组6.7％与G组6.7％相似(P=1.000)。结论 适当压力包扎加持续低负压吸引是预防乳癌术后皮下积液等并发症的有效的方法。

Objective To evaluate the effect of pressure dressings and drainage on seroma formation following modified radical mastectomy. Methods 70 patients with breast cancer were randomly divided into 3 groups. Patients in group A were placed with common dressings and common drains. Patients in group B were placed with pressure dressings and common drains. Patients in group C were placed with pressure dressings and suction drains (with 100 mmHg pressure in group C_1 and 26.7kPa pressure in group C_2). Results The mean drainage volume at first 24—hour was more in group B (140±33.4mL) than in group A(116.5±23.2ml) (P=0.014), more in group C (167±27.1ml) than in group B (P=0.003), and similar in group C_1 (162±25.4ml) and group C_2(172±28.6ml) (P=0.320). The total drainage volume was less in group B (389.5±38.7ml) than in group A (423q±45.1ml) (P=0.016), less in group C (346±44. 4ml) and group C_2 (340.7±32.6ml) (P=0.459). The time to drains removal was shorter in group B (8.2±2.2days) than in group A (10.1±2.7days) (P=0. 017), shorter in group C (6.4±1.5days) than in group B(P=0. 002), and similar in group C_1 (6. 321.4days) and group C_2 (6.6±1.6days) (P=0. 552). The seroma formation rate was lower in group B (30%) than in group A (65%) (P=0. 027), lower in group C (6.7%) than in group B (P=0. 027), and similar in group C_1 (6. 7%) and group C_2 (6. 7%) (P=1.000). Conclusion Pressure dressings and suction drainage are effective measures in prevention seroma formation following modified radical mastectomy.