乳腺癌根治性手术后皮瓣坏死的防治

Prevention and treatment of skin flap necrosis after radical operation for breast carcinoma

目的探讨乳腺癌术后皮瓣坏死的原因及预防措施,降低乳腺癌术后皮瓣坏死的发生率。方法对158例接受手术治疗的乳腺癌患者的临床资料进行总结,并分析不同手术方式、皮瓣厚度、皮瓣张力和皮瓣坏死之间的关系。结果158例乳腺癌手术患者中,32例(20.25%)发生皮瓣坏死。高张力皮瓣组皮瓣坏死率明显高于低张力皮瓣组(30.0%∶10.26%)(P<0.05);薄皮瓣组的坏死率高于厚皮瓣组(28.95%∶10.87%,P<0.05);在厚皮瓣组中,高张力皮瓣坏死率高于低张力皮瓣(21.43%∶2.00%,P<0.05);在薄皮瓣组,不同张力组之间,皮瓣坏死率没有显著差异(P>0.05)。结论皮瓣薄、皮瓣张力高是导致乳腺癌术后皮瓣坏死的重要原因,合理的皮瓣厚度、无张力皮瓣缝合、防止淋巴管漏及术后单管多孔引流是预防皮瓣坏死的重要方法。

Objective To explore the cause and prevention of skin flap necrosis after radical operation for breast cancer and reduce the incidence of skin flap necrosis. Methods The data of 158 patients with breast cancer who had surgical treatment were analysed. The data included the thickness of the skin flap, tension of the skin flap, and the mode of the operation and their relation with necrosis of the skin flap. Results Among the 158 operated cases, 32 cases （20.25 % ） had skin flap necrosis. The incidence of the flap necrosis in the thick skin flap group was lower than in the thin skin flap group （ 10.87 % vs28.95 % ,P 〈 0.05 ）. In the thick skin flap group, the incidence of the flap necrosis in the high tension flap group was higher than in the low tension group （21.43 % vs2.00 % ,P 〈 0.05 ）. In the thin flap group, there was no significant difference between high tension group and low tension group. Conclusions The results suggest that the key in prevention of skin flap necrosis is proper thickness of skin flap, perfect suture without tension, prevention of axillary lymphatic leakage and single porous tubular drainage.