乳腺癌根治性手术后减少皮瓣坏死的病因研究及防治

Study on cause of skin flap necrosis after redical operation and the preventive measures of carcinoma of breast

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,并分析了不同手术方式、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,薄皮瓣组的坏死率高于厚皮瓣组(分别为33.33%、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(分别为21.43%、2.00%,P<0.05);在薄皮瓣组,不同张力组之间,皮瓣坏死率差异没有显著性(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 reduce the incidence of the skin flap necrosis. [Methods] Reviewed and analysed 158 patients with the breast cancer surgical treatment. Studied the relations between the thickness of the skin flap, tension of the skin flap, the mode of the operation and the necrosis of the skin flap. [Results] The results showed that 32 cases （20.25%） suffured from 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% vs 33.33%）. In the thick skin flap group, the incidence of the flap necrosis in the high flap tension group was higher than in the low tension group （21.43% vs 2.00%）. In the thin flap group, there was no significant difference between high tension group and low tension group. [ Conclusions] This study suggests that the key of the prevention of skin flap necrosis is proper thickness of the skin flap, perfect suture without tension, prevention of the axillary lymphatic leaking and single porous tubular drainage.