乳腺癌改良根治术后皮下积液、皮瓣坏死、患肢淋巴水肿的原因分析与预防对策

Agent Analysis and Prevention Countermeasure of Subcutaneous Fluid Accumulation,Skin Flap Necrosis and Upper Limb lymphedema after Modified Radical Mastectomy

目的分析乳癌改良根治术后皮下积液、皮瓣坏死及患肢淋巴水肿的原因,并探讨其防治方法。方法对比改进组225例和对照组176例乳腺癌病人用不同的皮瓣游离法、不同的腋窝引流法和伤口包扎法所发生皮瓣下积液、皮瓣坏死及患肢水肿的区别。结果改进组及对照组术后出现皮下积液分别为13例(5.8%)及71例(40.3%),出现皮瓣坏死分别为5例(2.2%)及54例(30.7%),出现患肢水肿分别为0及42例(23.9%),三种并发症发生率均有统计学差异(P<0.01)。改进组和对照组术后腋窝引流量和引流时间分别为(350±50)ml vs.(430±70)ml,(5.7±0.7)d vs.(7.3±1.5)d,均有统计学差异(P<0.01)。结论通过改进皮瓣游离方法、腋窝引流的方法及伤口包扎方法,可明显降低术后皮下积液、皮瓣坏死及患肢水肿的发生率,减轻患者痛苦。

Objective To explore the methods of preventing subcutaneous fluid accumulation,skin flap necrosis and upper limb lymphedema after modified radical mastectomy.Methods There were 401 cases of breast cancer enrolled in this study,including 225 cases underwent modified measures and 176 cases underwent conventional treatment.Results In the modified and conventional group,the rate of subcutaneous fluid accumulation was 5.8%（13/225） vs.40.3%（71/176）;the rate of skin flap necrosis was 2.2%（5/225） vs.30.7%（54/176）;and the rate of upper limb lymphedema was 0 vs.23.9%（42/176） respectively.There were significantly differences in these three complications（P〈0.01）.The axillary drainage quantity was（350±50） ml vs.（430±70） ml;and the drainage duration was（5.7±0.7）d vs.（7.3±1.5）d.Both of them had significant differences（P〈0.01）.Conclusion The improved flap separation method and wound management can decrease the rate of subcutaneous fluid accumulation,skin flap necrosis and upper limb lymph edema after modified radical mastectomy.