保乳手术使用切口保护、开创器与常规方法的手术效果比较

Compare the effect of operation between using incision protective retractor and traditional way in breast conserving-surgery

目的比较保乳手术中，使用切口保护、开创器或常规手术方法，两者清扫腋窝淋巴结之手术效果。方法（1）将实施保乳手术的乳腺癌患者分为A、B两组。A组34例，为常规手术方法；B组31例，在术中腋窝淋巴结清扫时，使用切口保护、开创器。（2）根据腋下术区长短径之比、术区显露解剖结构数目、术中使用手术拉钩情况，权重判分。手术视野显露最佳者为10分，最差者0分。（3）根据腋下切口长度分别计6～10分，切口越短计分越高。结果（1）手术显露效果平均得分：A组（3．03±1．06）分，B组（9．29±0．94）分，两者相比差异有统计学意义（P〈0．001）。（2）腋下切口长度计分平均分值：A组（5．0±1．33）分，B组（9．87±0．50）分，两者相比差异有统计学意义（P〈0．001）。（3）手术切口皮缘坏死、牵拉伤或被电刀烫伤情况发生率分别为，A组8．82％，B组6．45％，两者相比差异无统计学意义（P〉0．05）。结论（1）由于切口保护、开创器的支撑与均匀牵拉作用，可使术野整体显露良好。（2）借助切口保护、开创器这一新器械，在保障保乳手术根治性的同时，可减小手术创伤，增强美容效果。

Objective To compare the effect of axiUary lymph node dissection between using in incision protective retractor and traditional way in breast conserving - surgery. Methods （1） Divided the patients of breast cancer who would accept conserving - surgery into two groups ： A and B. A were 34 cases in traditional way , B were 31 cases using incision protective retractor in axiUary lymph node dissection. （2）According to the ratio of longitude and latitude of operation area, the numbers of anatomy structure to reveal in operation area and the situation of using operation retractor in operation, weight to judge. （3）To reveal the operation field , the best is 10 points, the worst is 0 points. Counting 6--10 points according to the length of armpit incision, the shorter the incision, the higher the point. Results （1） The average points of the effect of reveal, A were （ 3.03 ± 1.06 ） , B were （ 9.29 ± 0.94 ）, difference is significant （ P 〈 0.001 ）. （2） The average point of the length of incision of armpit ： A were （ 3.03 ± 1.06 ） , B were （9.29 ± 0.94）, difference is significant（ P 〈 0.001 ）. （3） The incidence of necrosis, tension injury or electro scalpel empyresis in skin edge of operative incision , A were 8.82% , B were 6.45% , difference is no significant（ P 〉 0.05 ）. Conclusions （1） By using incision protective retractor can achieve to good reveal of operation field without the drag of assistant. （2）The armpit incision along dermo ridge is about 5--6 cm, it is aesthetic and masked. （3）By using incision protective retractor in the meantime of ensure the effect of radical cure of conserving - surgery can decrease the surgical trauma and increase the cosmetic result.