负压引流预防乳腺麦默通切除术后血肿形成的初步临床研究

Negative pressure drainage in preventing hematoma post Mammotome surgery in breast disease:a preliminary clinical study

目的 :探讨负压引流预防乳腺病变麦默通切除术后乳房的血肿形成。方法 :研究对象为接受麦默通手术的乳腺病变病人,存在术后高危出血风险。在麦默通切除病变后,即刻放置残腔负压引流管,观察并分析术后引流情况及影响引流的相关临床病理因素。结果:本研究共80例病人,术中通过超声引导,均成功放置负压引流管。术后第1天引流量≥30 mL、>10~<30 mL以及≤10 mL的病例分别为3例、32例和45例。单因素分析显示,肿块大小、肿块位置以及术前超声检查提示肿块内血流丰富与术后第1天引流量>10 mL显著相关。多因素分析显示,肿块最大径>2 cm(OR=14.47,95%CI:3.58~58.53,P<0.001)和肿块内血流丰富(OR=5.13,95%CI:1.41~18.69,P=0.013)是术后第1天引流量>10 mL的独立影响因素。术后1个月随访,病人术后患侧乳房无明显血肿和皮肤淤斑形成。结论:对于乳腺病变接受麦默通切除手术,特别是肿块最大径>2 cm或超声检查提示肿块内血流丰富的病人,术后负压引流可减少术后血肿及皮肤淤斑形成。

Objective To analyze the role of negative pressure drainage in preventing postoperative hematoma in the patients with breast disease who received Mammotome micro-invasive surgery. Methods The patients with breast disease who received Mammotome surgery at high risk of bleeding were enrolled into this study. Negative pressure drainage tube was immediately placed into the residue cavity. Postoperative drainage volume and the related clinicpathological factors were recorded and analyzed. Results There were 80 patients in this study. Negative pressure drainage tubes were all placed successfully under ultrasound guidance. Three cases had drainage volume ≥30 mL, 32 cases had 10-30 mL and 45 cases had ≤10 mL during the first postoperative day. It was found with univariate analysis that the factors including mass size and location, and blood flow in the breast mass shown with ultrasound scanning were associated with drainage volume 10 mL first postoperative day. Multivariable analysis showed that the factors of breast mass both 2 cm in maximum diameter（OR=14.47, 95%CI： 3.58-58.53, P0.001） and fast blood flow（OR=5.13, 95%CI： 1.41-18.69, P=0.013）were independently related with drainage volume 10 mL first postoperative day. Hematoma and skin ecchymosis was not found postoperative one-month later by follow-up. Conclusions Negative pressure drainage after Mammotome surgery might be effective for the patients with breast disease to decrease postoperative hematoma formation and skin ecchymosis especially when 2 cm in maximum diameter or fast blood flow in the breast mass shown by ultrasound examination.