B超引导下刮除纤维包囊辅助双层负压封闭引流治疗乳腺癌术后顽固性血清肿

Treatment of refractory seroma after mastectomy by B-ultrasound guided scraping of fibrous capsule and vacuum assisted closure dressing

目的 探讨在B超引导下,经小切口刮除纤维包囊,术后辅助双层负压封闭引流在乳腺癌术后顽固性血清肿治疗中的作用和价值.方法 自2009年7月至2012年9月,对24例乳腺癌术后顽固性血清肿患者,术前和术中经B超定位,标记血清肿的范围,并测定其容积和纤维包囊的厚度.对血清肿边缘做长约1.5cm切口,在B超引导下,经小切口用带齿刮匙刮除血清肿周围纤维包囊,予双层负压封闭引流包扎伤口.刮除的纤维囊组织送病理检查.结果 24例乳腺癌术后顽固性血清肿容积24.0cm×16.0cm×4.0cm^8.0cm×5.0cm×1.0cm,平均血清液（88.6±6.7）ml.术前和术中B超在血清肿周围均探测到增厚纤维包囊;在B超引导下,经1.5cm小切口能够安全有效地刮除血清肿周围的所有纤维包囊,对皮肤组织损伤小,同时可避免腋区血管神经的损伤.术后辅助使用双层负压封闭引流时间平均为（7.2±3.3）d,患者伤口均Ⅰ期愈合.随访3~12个月均无复发.病理检查见刮除组织为增生的纤维组织,其表面有单层上皮样细胞覆盖,这种单层上皮样组织免疫组织,化学检查见CD31 、D2-40和Ki-67染色阳性.结论 B超引导下小切口微创刮除纤维囊,术后辅助双层负压封闭引流能够有效治疗乳腺癌术后顽固性血清肿.

Objective To investigate the effects of ultrasound-guided scraping of fibrous capsule and vacu- um assisted closure （VAC） dressing on refractory seroma after mastectomy. Methods From July 2009 to Sept em- ber 2012, 24 patients with chronic seroma received ultrasound-guided scraping of fibrous capsule around refractory seroma, and then the wounds were treated with VAC dressing therapy. The time of VAC application and wound heal- ing were noted, and pathological examinations were made for the removed fibrous tissues. Results Ultrasound- guided scraping was safe and minimally invasive, and all fibrous capsule tissues around the seroma could be removed with a 1.5 em incision. All refractory seroma in 24 patients healed uneventfully after an average application of VAC addressing technique for 7.2 ±3.3 days, and there was no recurrence in all 24 patients during 3 - 12 months follow- up. Immunohistochemistry staining showed that the scraped samples contained epithelioid tissues with positive ex- pression of CD31, D2-40 and Ki-67. Conclusion Ultrasound-guided scraping of fibrous capsule plus VAC dressing therapy is minimally invasive and can promote wound healing of refractory seroma after masteetomy.