乳腺癌改良根治术后腋窝积液防治对策的探讨

Study on prevention of axillary seroma formation after modified radical mastectomy

目的:分析乳腺癌改良根治术后腋窝积液的发生原因和影响因素,探讨减少腋窝引流量及缩短引流时间的方法。方法:回顾性分析2007-01-2008-12我院收治的105例乳腺癌改良根治术病例的临床资料,筛选影响腋窝积液发生的7个相关因素,以Logistic回归方法进行分析,确定风险因素;再针对导致腋窝积液发生的危险因素进行前瞻性干预研究。将2009-01-2010-06收治的152例乳腺癌病例随机分为3组,比较不同的腋窝处理方式对腋窝积液发生率、引流量及持续时间的影响。结果:回顾组32例(30.48%)发生腋窝积液,其中淋巴漏性积液占46.9%,渗出性积液占37.5%。对所收集的7个相关因素应用SPSS 13.0软件进行Logistic回归分析,在α=0.05水平上筛选出3个乳腺癌术后发生腋窝积液的危险因素,分别为合并糖尿病(OR=4.520)、转移淋巴结个数(OR=3.762)和术后肩关节过早活动(OR=2.939)。丝线结扎+腋窝成型组腋窝积液的发生率为3.92%,与超声刀封闭+腋窝成型组相近(发生率为4%,P=0.800),明显低于单纯腋窝成型组(发生率为17.64%,P=0.051),且两组的引流量和拔管时间也明显低于单纯腋窝成型组,但两组之间差异无统计学意义;单纯腋窝成型组和回顾组在积液发生率、拔管时间差异均无统计学意义,但引流量明显低于回顾组〔533(178)vs 689(269.5)〕,χ2=4.7,P=0.000。结论:真性淋巴漏和创面渗出是导致腋窝积液的主要原因;腋窝成型术能有效消灭腋窝死腔,显著降低引流量;彻底结扎腋窝淋巴管可缩短引流时间;两者综合应用可以有效预防腋窝积液的发生。

OBJECTIVE： To analyze the risk factors of axillary seroma formation and explore the methods of reducing the axillary drainage volume and duration after modified radical mastectomy. METHODS： Retrospectively analyzed 105 patients from January 2007 to December 2008 who has undergone modified radical mastectomy. The source of the axillary seroma and the related risk factors on seroma formation were investigated. Seven factors related to seroma formation were analyzed with Logistic regression to identify the risk factors. The 152 patients were subdivided into three groups： suture ligation group（n= 51）, the operations were performed by clamp-and-tie techniques with axillary reconstruction; UAS group （n=50）, the operations were performed by using the harmonic scalpel with axillary reconstruction; electrocautery group （ELC, n=51）, the operations were performed by monopolar electric scalpel with axillary reconstruction. Age and clinical stage of tumor of the three groups were similar. Major indexes to observe and compare included drainage volume and duration and incidence of seroma. RESULTS： Thirdty-two patients （30.48 %） developed an axillary seroma in retrospective group. The reasons of seroma formation mainly included lymphorrhea 46.9 %and exudative hydrops 37.5 %. Multivariate analysis using logistic regression model showed that diabetes （OR = 4.520）, number of metastatic lymph nodes （OR=3.762） and early postoperative shoulder exercise（OR=2.939） independently correlated with seroma formation. The incidence of the suture ligation group was 3.92%, similar to UAS group 4% （P= 0.800）, significantly lower than that in ELC group 17.64% （P=0.051） and the retrospective group 30. 480% （P=0.000）. Axillary reconstruction could effectively close the axillary fossa space and reduce the total drainage volume. A thorough lymphatic ligation could reduce duration of drainage. CONCLUSION： Lymphorrhea and exudation are the main reasons for seroma formation.A thorough lymphatic ligation and the eradication of residual axillary cavity may be the key to prevention of seroma formation.