腋下皮瓣缝合内固定预防乳腺癌改良根治术后血清肿的临床研究

A controlled clinical study for axillary skin flap internal fixation in reducing seroma formation after modified radical mastectomy

目的对比乳腺癌改良根治术中腋下皮瓣缝合内固定与无固定缝合术后拔管时间、引流量和血清肿发生率的差异,探讨预防乳腺癌改良根治术后血清肿的有效方法。方法回顾性分析2015年6月至2017年5月首都医科大学附属北京同仁医院普外科收治的125例行乳腺癌改良根治术患者的病例资料,其中行腋下皮瓣缝合内固定者67例,无固定缝合者58例。比较两组患者术后拔管时间、引流量和血清肿发生率的差异。结果腋下皮瓣缝合内固定组平均拔管时间为(7.96±1.89)天,明显短于无固定缝合组的(13.55±4.76)天,差异有显著性(P<0.01)。腋下皮瓣缝合内固定组平均引流总量为(525.15±153.66)ml,明显低于无固定缝合组的(737.24±321.08)ml,差异有显著性(P<0.01)。腋下皮瓣缝合内固定组术后血清肿发生率为7.46%,明显低于无固定缝合组的29.31%,差异有显著性(P<0.01)。结论腋下皮瓣缝合内固定可显著降低乳腺癌改良根治术后血清肿的发生率,减少引流时间和引流量,操作简便,是预防术后血清肿的有效方法。

Objective To compare the days before drain removal, the total amount of drain output and the rate of postoperative seroma formation between patients with axillary skin flap internal fixation and without fixation after modified radical mastectomy for breast cancer. A new technique to minimize seroma formation was investigated. Method We reviewed retrospectively 125 breast cancer patients undergoing modified radical mastectomy in the Department of General Surgery of Capital Medical University Beijing Tongren Hospital from June 2015 to MAY 2017. Of these patients, 67 underwent axillary skin flap internal fixation and 58 without fixation. The days before drain removal, the total amount of drain output and the rate of postoperative seroma formation between the two groups were compared. Result The mean of days before drain removal was （7.96±1.89） day in axillary skin flap internal fixation group while was （13.55 ±4.76） day in no fixation group. The drain was removed in significantly shorter time in the axillary skin flap internal fixation group compared to the no fixation group （P〈0.01）. The mean total amount of drain output was （525.15 _＋ 153.66）ml in axillary skin flap internal fixation group while was （737.24 ＋ 321.08）ml in no fixation group. The total amount of fluid drained was significantly lower in the axillary skin flap internal fixation group compared to the no fixation group （P〈 0.01）. The morbidity of seroma formation was 7.46% in the axillary skin flap internal fixation group while was 29.31% in no fixation group. The frequency of seroma formation was significantly lower in the axillary skin flap internal fixation group compared to the no fixation group （P〈0.01）. Conclusion The axillary skin flap internal fixation technique can significantly decrease the incidence of seroma formation and reduce the duration and amount of drained fluid. It is a simple and useful technique to minimize seroma formation.