乳癌改良根治术后皮瓣坏死的预防

Prevention of skin flap necrosis after modified radical operation of breast cancer： analysis of 156 cases

目的探讨乳腺癌改良根治术后皮瓣坏死的预防途径。方法95例1997年6月前治疗的乳腺癌患者接受乳癌根治术（对照组），60例1997年7月后接受治疗者接受乳癌改良根治术（研究组）：保留皮下脂肪，尤其是在厉切口3cm以上的地方，创口置双管引流、持续负压吸引，降低皮瓣缝合处的张力。观察皮瓣坏死、皮下积液等指标的情况。结果研究组皮瓣坏死的发生率为3．3％（2／60），显著低于对照组（26．3％，25／95，P〈0．05）。研究组的皮下积液发生率为5．0％（3／60），显著低于对照组（30．5％，29／95，P〈0．05）。结论严密缝合切口、防止腋下淋巴管瘘、创口置双管引流、持续负压吸引、合适的胸带包扎力、合理的皮瓣厚度以及皮瓣缝合不能有或零张力，是预防乳腺癌根治术后皮瓣坏死的关键。

Objective To investigate the strategy to prevent skin flap necrosis after modified radical operation of breast cancer. Methods Ninety-five patients with breast cancer, all females, aged 56, treated before June 1997, underwent routine radical operation with all the subcutaneous fat removed, and 60 patients, all females, aged 53, treated after July 1997, underwent modified radical operation with the subcutaneous fat reserved, especially the fat 3 em away from the incision, ligation of all local lymph vessels, and continued drainage. Results The incidence of skin flap necrosis of the experiment group was 3.3% （2/60）, significantly lower than that of the control group （26.3%, 25/95, P〈0.05）. The subdermal hydrops rate of the experiment group was 5.0% （3/60）, significantly lower than that of the control group （30.5%, 29/95, P〈0.05）. Conclusion The keys to prevent skin flap necrosis after radical operation of breast include reservation of subcutaneous fat, double-tube drainage, appropriate chest band enswathing, low suture tension, and continuous vacuum suction.