乳腺癌术后皮瓣坏死原因和预防措施的探讨

Causes of Skin Flap Necrosis after Breast Cancer Surgery and Preventive Measures

目的分析乳腺癌术后皮瓣坏死的原因及探讨防治措施。方法对64例乳腺癌患者术后的临床资料进行总结,回顾性分析手术方式、切口选择、皮瓣厚度、皮瓣张力、单管或双管引流与皮瓣坏死程度的关系。结果 64例乳腺癌患者中,术后皮瓣坏死12例,占18.75%。皮瓣坏死与切口选择、皮瓣厚度和皮瓣张力单或双管引流有关(P<0.05)。采用横形切口11.63%(5/43)、厚皮瓣10.26%(4/39)、低张力皮瓣8.33%(3/36)、双管引流5.00%(1/20)者的皮瓣坏死发生率分别较纵梭形切口(33.33%,7/21)、薄皮瓣(32.00%,8/25)和高张力皮瓣(32.14%,9/28)、单管引流(25.00%,11/44)者低,差异有统计学意义(P<0.05)。结论乳腺癌术后皮瓣坏死原因是多方面的,皮瓣供血不足是术后皮瓣坏死的根本原因。合理的选择手术切口,选择适当厚度的皮瓣,无张力缝合,保护皮瓣血运,术后双管引流等是防治皮瓣坏死的关键措施。

Objective To explore the causes of skin flap necrosis after breast cancer surgery and the preventive measures.Methods The clinical data such as the operation methods,proper surgical incision selection,thickness and tension of the flaps,single or double drain,and degree of skin flap necrosis were retrospectively analyzed in sixty four patients with breast cancer.Results Twelve in 64 patients（18.75%） were with skin flap necrosis after the surgery.The necrosis was related to the incision,thickness and tension of flap,single or double tube drain（P0.05）.The rate of necrosis was：11.88（horizontal skin incision） vs.longitudinal fusiform incision（33.33%）;10.26%（thick flap） vs.32.00%（thin flap）;8.33%（low tension flap） vs.32.14%（high tension flap）;5.00%（double tube drain） vs.single tube drain（25.00%）,and the difference was statistically significant（P0.05）.Conclusion In the many factors of skin flap necrosis after surgery,flap ischemia is the key one.The proper surgical incision,thickness of skin flap,tension-free suture,protect skin flap blood,double drain are the key measures to control skin flap necrosis.