微创置管接负压吸引器引流联合抗菌药物治疗乳腺癌术后皮瓣下积液伴感染的临床疗效及对TNF-α与IL-8和PCT的影响

Effect of minimally invasive catheterization and negative pressure aspiration drainage combined with antimicrobial agents on the treatment of postoperative subcutaneous effusion in patients with breast cancer and its effect on TNF-α,IL-8 and PCT

目的微创置管接负压吸引器引流法合并抗菌药物对乳腺癌术后皮瓣下积液伴感染治疗的临床效果及对炎症因子的影响。方法选取2014年1月-2016年12月医院收治的120例女性行改良乳腺癌根治术合并皮瓣下积液患者作为研究对象,按照随机数字表法分为对照组和试验组,每组60例。对照组采取细针穿刺抽吸加压引流法,试验组患者采取微创置管接负压吸引器引流法,并根据患者自身状况静脉注射头孢唑林或哌拉西林行抗感染治疗。对两组患者的腹腔下积液进行细菌培养,检测病原菌;观察两组患者皮瓣下积液痊愈率及痊愈时间;观察两组患者的治疗时间、换药次数、头孢唑林或哌拉西林的用量;测定两组患者治疗前和治疗后1周血清中肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)及血清降钙素原(PCT)的含量。结果两组患者皮瓣下积液细菌培养结果显示,对照组检测出菌株65株,试验组中检测出菌株67株;试验组患者的痊愈天数为(4.26±0.94)d,少于对照组患者的(9.67±2.61)d(P<0.001);试验组患者的治疗时间、换药次数、头孢唑林及哌拉西林的用量较对照组患者减少(P<0.05);治疗1周后,两组患者血清中TNF-α、IL-8及PCT含量均下降(P<0.05),试验组患者血清中TNF-α、IL-8及PCT的含量低于对照组患者(P<0.05)。结论微创置管接负压吸引器引流法合并抗菌药物治疗乳腺癌术后皮瓣下积液伴感染具有良好的临床效果,减少治疗时间、换药次数及抗菌药物的使用。

OBJECTIVE To investigate the effect of minimally invasive catheterization and negative pressure aspirator drainage combined with antimicrobial agents on postoperative subcutaneous effusion in breast cancer patients with infection and its effect of inflammatory factors.METHODSAtotal of 120 women who underwent radical mastectomy from Jan.2014 to Dec.2016 and suffered from subcutaneous effusion were enrolled in this study,and divided into the control group and the observation group according to the random number table method,with 60 cases in each group.The patients in the control group were treated with fine needle aspiration and pressurized drainage method,whereas those in the observation group were treated with minimally invasive catheterization and negative pressure aspirator drainage method,and the patients were treated with cefazolin or piperacillin by intravenous injection according to the patient’s individual condition.Bacterial culture of peritoneal effusion was conducted for the two groups of patients to detect the pathogens.The healing rate and recovery time of subcutaneous effusion in the two groups of patients were observed.The treatment time,number of dressing and dosage of cefazolin or piperacillin in the two groups of patients were also observed.The levels of tumor necrosis factor-α(TNF-α),interleukin-8(IL-8)and serum procalcitonin(PCT)in the serum of the two groups were measured before treatment and 1 week after treatment.RESULTS The bacteria culture results of peritoneal effusion showed 65 and 67 strains of pathogens detected respectively from the control group and the observation group.The number of days taken to be recovered in the observation group was(4.26±0.94)days,which was significantly lower than that in the control group(9.67±2.61)d(P<0.001).The duration of treatment,number of dressing,and the dosage of cefazolin and piperacillin in the observation group were significantly reduced(P < 0.05).After 1 week of treatment,the levels of TNF-α,IL-8 and PCT in the serum of the two groups were both significantly decreased(P<0.05),and compared with the control group,the levels of TNF-α,IL-8 and PCT in the serum of the observation group were significantly lower(P<0.05).CONCLUSION Minimally invasive catheterization and negative pressure aspirator drainage combined with antimicrobial agents has a good clinical effect for the treatment of breast cancer patients with postoperative subcutaneous effusion and infection,significantly reducing the treatment time,the number of dressing and the use of antibiotics,and is worthy of clinical Promotion.