乳腺癌改良根治术中改进体位的应用研究

The study of the improved surgical position in modified radical mastectomy for breast cancer

目的观察乳腺癌改良根治术中改进体位的应用效果。方法选取2014年8月—2016年8月行乳腺癌改良根治术的患者80例。患者按照手术体位不同分为改进组和传统组,各40例。改进组手术体位为患侧腋后线与床边缘及头顶部与床头边缘对齐,选用合适垫枕将腋窝抬高,对术者与助手术中操作位置和方式进行调整;传统组采用常规仰卧位。观察2组手术时间、术中出血量、术中无影灯调节次数、患者术后情况、医生舒适度、患者满意率。结果改进组的手术时间、术中出血量、无影灯调节次数等均少于传统组[(92.5±8.1)min vs(110.7±15.9)min、(74.4±6.8)m L vs(85.2±5.6)m L、(6.7±1.4)次vs(8.1±2.3)次,P<0.05];改进组上肢皮肤压红、上肢外展>90°发生例数均少于传统组(2例vs 13例、0例vs 9例,P<0.05);改进组的医生舒适度、患者满意率均高于传统组(97.5%vs 75.0%、95.0%vs 70.0%,P<0.05)。结论乳腺癌改良根治术中改进体位的应用安全有效,能提升手术医生便利性和舒适度,确保手术安全。

Objective To observe the application of improved surgical position in modified radical mastectomy for breast cancer. Methods Totally 80 cases of breast cancer patients were divided into improved group( n = 40) and traditional group( n = 40) according to different surgical positions. Patients in the control group adopted the supine position during surgery,and those in the observation group adopted the improved position. The primary outcomes were operation duration,intraoperative blood loss,shadowless lamp adjustment times,and postoperative condition.The comfort level of surgeons and satisfaction degree of patients were evacuated. Results The operation duration,intraoperative blood loss,shadowless lamp adjustment times were lower in the improved groupthan those of the traditional group( [92. 5 ± 8. 1]min vs. [110. 7 ± 15. 9]min,[74. 4 ± 6. 8]mL vs.[85. 2 ± 5. 6]mL,[6. 7 ± 1. 4]times vs. [8. 1 ± 2. 3]times,P < 0. 05).There were fewer patients with skin flushing or hyperabductedupper limb( > 90°) in the improved groupthan that of the traditional group( 2 cases vs. 13 cases,0 vs. 9 cases,P < 0. 05). The comfort level of surgeons and satisfaction degree of patients were higher in the improved groupthan those of the traditional group( 97. 5% vs 75. 0%,95. 0% vs 70. 0%,P < 0. 05). Conclusion Improved surgical position can bring benefits not only to surgeons,but also patients in modified radical mastectomy for breast cancer.