乳腺癌根治术后皮瓣坏死的防治

Prevention and treatment of skin flap necrosis after breast cancer radical mastectomy

目的分析乳腺癌根治术后皮瓣坏死的发生原因及防治方法。方法对2000年5月～2006年11月我院收治的337例乳腺癌根治术患者的临床资料进行回顾性分析。结果337例乳腺癌根治术后有53例发生术后皮瓣坏死,发生率15.7%。结论预防乳腺癌根治术皮瓣坏死的关键是防止淋巴管瘘的发生,腋窝、胸骨旁、肋弓处畅通有效的引流,游离皮瓣的保护和合理的厚度,合适的胸带固定,无张力缝合以及有回路的、主动持续性低负压中心吸引引流等措施。

[Objective] To analyse the causes and treatment for necrosis of skin flap following breast cancer modified radical mastectomy. [Methods] The clinic data of 336 cases with breast cancer treated in hospital from May. 2000 to Oct. 2006 was analyzed retrospectively. [Results] There were 32 cases with skin flap necrosis among 336 cases treated by breast cancer radical mastectomy, the necrosis rate of skin flap was 9.52%, all the cases were successfully cured. [Conclusions] In the breast cancer radical mastectomy, the keys to prevent the necrosis rate of skin flap are： prevention of lymphatic fistula, two tubular drainage set individually in subaxillary, parastemal and subcostalis, proper thickness and protection of skin flap, appropriate chest bandaging fixed onto the chest wall, perfect suture without tension and active subpmssure aspiration drainage.