皮瓣修复对乳腺癌术后溃疡创面伴发淋巴水肿的疗效观察

Clinical Observation of Reconstructive Surgery with a Skin Flap Used in the Treatment of an Ulcerated Wound with Lymphedema after Radical Mastectomy

目的观察分析乳腺癌根治术后溃疡创面合并淋巴水肿患者皮瓣修复的临床治疗效果。方法收集3年来我院乳腺癌根治术后溃疡创面合并淋巴水肿患者29例,其中邮票植皮8例、大张自体皮移植6例、皮瓣修复15例,观察患者创面愈合、淋巴水肿改善、后期瘢痕增生情况。结果创面愈合时间3组对比差异不显著(P>0.05);邮票植皮能改善部分水肿,其与大张植皮效果相近(P>0.05),皮瓣修复创面能明显改善患者上肢淋巴水肿(P<0.01);后期邮票植皮患者瘢痕增生最重,大张植皮居中,皮瓣修复瘢痕增生情况发生较少。结论皮瓣修复乳腺癌根治术后溃疡创面合并淋巴水肿临床疗效确切,淋巴水肿改善明显,远期瘢痕增生轻。

Objective To observe the therapeutic effect of reeonslvuetive surgery, with a skin flap used in the treat- ment of an uh＇erated wound with lymphedema after radical mastcetnmy. Methods 29 patients, with the complicaton of an ulcerated wound associated with lymphedema after radical masteetnmy, were admitted into our hospital （luring the past three years. 8 eases were given stamp skin-grafting, 6 eases were given large sheet autologous skin grafting and 15 eases were reeonstructed with skin flap. Wound healing days, improvement of lymphedema and scarring were observed. Results The difference among the three groups with respect to wound healing clays was not remarkable （P〉0. 05 ）. Stamp skin-grafting could partially relieve lymphedema that was close to the large sheet autologous skin-grafting （ P 〉 0. 05 ） , hut a skin flap could apparently alleviate the lymphedema in the upper extremities （P 〈 0. 01 ）. At a later stage, scarring in patieuls given stamp skin-grafting was the most serious, scarring in patients given large sheet autologous skin graft was less, and scarring in patients given skin flap reconstruction was the least. Conclusion Reconstructive surgery with a skin flap in the treat- merit of an ulcerated wound with lymphedema after radical masteetomy is obviously effective with an obvious alleviation of lymphedema and lessening of scarring in the long run.