超声刀联合脂肪溶解液在乳腺癌腋窝淋巴结清除术中应用研究

Axillary lymph node dissection with ultracision harmonic scalpel combined with fat-soluble liquid in breast cancer

目的乳腺癌改良根治术腋窝淋巴结清除术后常有出血,积液及损伤腋窝神经等并发症,精细解剖是较为可靠的方法。本研究应用超声刀联合脂肪溶解液行乳腺癌腋窝淋巴结清除术,探讨其可行性和安全性。方法回顾性分析青岛市胶州中心医院2013-06-15-2015-04-25乳腺癌改良根治术患者210例临床资料,随机分为超声刀联合脂肪溶解液组（研究组）和高频电刀组（对照组）两组,每组105例。研究组应用Harmonic超声刀配备Focus刀头联合脂肪溶解液行乳腺癌腋窝淋巴结清除术;对照组用高频单极电刀行腋窝淋巴清除术。两组进行对比,观察腋窝清除手术时间、腋窝手术出血量、引流总量及腋窝引流时间等指标并进行统计学分析。结果研究组腋窝清除术时间为（20.4±9.7）min,短于对照组（31.5±7.8）min,t=2.813,P=0.021;研究组术中出血为（44.3±5.2）mL,少于对照组（75.7±7.9）mL,χ^2=7.445,P=0.046;研究组淋巴引流总量为（253.6±5.6）mL,较对照组（357.7±8.9）mL少,χ^2=7.234,P=0.018;研究组超声刀溶脂组术后腋窝引流时间为（6.5±1.5）d,较对照组（12.1±2.6）d明显缩短,χ^2=6.356,P=0.025。两组清除腋窝淋巴结数目差异无统计学意义,P〉0.05。结论与高频单极电刀相比,应用超声刀联合脂肪溶解液行乳腺癌腋窝淋巴结清除术,可以缩短手术时间,减少手术出血量和术后腋窝引流时间。两者可以协同发挥作用,安全可靠。

OBJECTIVE There were often complications such as bleeding,effusion and damage of axillary nerve in breast cancer modified radical axillary lymph node removal surgery.It is a reliable way to fine dissection.This study introduced the use of ultrasonic harmonic scalpel combined with fat-soluble liquid in axillary lymph node dissection in mastectomy of breast cancer,to explore the feasibility and safety.METHODS Totally 210 patients with breast cancer modified radical from June 15,2013 to April 25,2015 were retrospectively analyzed.They were randomly divided into ultrasonic harmonic scalpel combined with fat-soluble liquid（team）and high frequency electric knife group（control group）with105cases in each.The team applied Harmonic ultrasonic harmonic scalpel with Focus segment combined with fat-soluble liquid for removal of axillary lymph nodes of breast cancer.The control group applied high frequency electric knife for removal of axillary lymph nodes of breast cancer.In the two groups,the axillary clearance operation time,axillary surgery the bleeding,drainage volume and axillary drainage time indicators as well as statistical analysis were compared.RESULTS The research group[（20.4±9.7）min]for removal of axillary operation time was shorter than that of the control group[（31.5±7.8）min]（t=2.813,P=0.021）.The bleeding amount in the research group[（44.3±5.2）mL]was lower than that in control group[（75.7±7.9）mL]（χ^2=7.445,P=0.046）.Lymphatic drainage amount in the research group[（253.6±5.6）mL]was less than[（357.7±8.9）mL]（χ^2=7.234,P=0.018）.The team of postoperative drainage time[（6.5±1.5）d]was shorter than that of the control group[（12.1±2.6）d]（χ^2=6.356,P=0.025）.The differences were statistically significant.No obvious difference was found between two groups of contrast cleaning number of axillary lymph node（P〈0.05）.CONCLUSIONS Compared to monopolar electro diathermy,the using of ultrasonic harmonic scalpel Combined with fat-soluble liquid in axillary lymph node dissection in mastectomy of breast cancer can shorten the operation time and the drainage duration,it is a kind of safe and reliable operation method.