乳腺癌改良根治术后皮下积液的高危因素

High- risk factors of seroma for breast cancer patients treated with modified radical mastectomy

目的：分析乳腺癌改良根治术后发生皮下积液的危险因素,并探讨相应的干预对策。方法：回顾分析2009年3月至2013年3月,我院收治的40例乳腺癌行改良根治术并发皮下积液的患者资料,同时搜集性别、民族相同、年龄相差3岁内未发生皮下积液行改良根治术的乳腺癌患者,配对的患者手术时间相差在一周内,手术操作均为同一医生和同一组护理人员,进行1∶2配对。对两组患者的年龄、民族、手术时间、肿瘤发生部位、肿瘤大小、手术切口类型及既往病史、用药等资料进行统计分析。随访患者术后皮下积液的情况。结果：对是否发生术后皮下积液的两组患者进行单因素和多因素影响分析,糖尿病（OR=1.886,95%CI：0.379~11.502）、淋巴结转移（OR=4.845,95%CI：1.465~16.342）、生物蛋白胶的使用（OR=0.302,95%CI：0.135~0.675）是乳腺癌改良根治术后发生皮下积液的危险因素。有基础疾病、淋巴结转移的乳腺癌改良根治术后发生皮下积液可能性是无基础病、无淋巴结转移患者的1.886倍、4.845倍。使用生物蛋白胶的乳腺癌改良根治术后发生皮下积液的可能性是不使用生物蛋白胶的0.302倍。乳腺肿瘤发生部位、肿瘤大小、手术切口类型与乳腺癌术后皮下积液无明显相关（P〉0.05）。结论：合并有基础疾病、淋巴结转移的乳腺癌患者行改良根治术后易发生皮下积液。使用生物蛋白胶的乳腺癌患者行改良根治术后发生皮下积液的可能性降低。肿瘤发生部位、肿瘤大小、手术切口类型与乳腺癌术后皮下积液无明显相关。

Objective： To analyze the risk factors of seroma for breast cancer patinets traeteded with modified radical mastectomy. Methods： All 40 breast cancer patients complicating seroma treated with modified radical mastectomy were selected,and 80 breast cancer patients treated with modified radical mastectomy were selected as controls in two groups gender,age,nation hadn＇ t significant differences. Results： Underlying diseases（ OR = 1. 886,95% CI： 0. 379~ 11. 502）,lymph node metastasis（ OR = 4. 845,95% CI： 1. 465 ~ 16. 342）,biological the use of fibrin glue（ OR =0. 302,95% CI： 0. 135 ~ 0. 675） were modified radical mastectomy postoperative seroma risk factors. Breast tumor location,tumor size,type of breast cancer after surgical incision seroma had no significant correlation（ P〈0. 05）. Conclusion： Underlying disease,breast cancer modified radical lymph node metastasis of breast cancer after modified prone to subcutaneous fluid,using fibrin glue radical possibility reduced postoperative subcutaneous fluid. Tumor location,tumor size,surgical incisions type and breast cancer seroma had no significant correlation.