乳腺癌改良根治手术并发症的发生原因及预防对策

Causes and preventive measures of complications of modified radical mastectomy for breast cancer

目的探讨乳腺癌改良根治术并发症的发生原因及预防对策。方法选取2014年1月~2017年12月我院收治的60例乳腺癌改良根治术患者作为观察对象,对患者的临床资料进行回顾性分析,结合是否发生并发症,将其分为并发症组(23例)和未发生并发症组(37例)。研究乳腺癌改良根治术并发症的发生原因及预防对策。结果并发症组的手术切口选择不当率、术中未彻底止血率、腋窝清扫范围不合理率、电刀应用不当率、皮瓣游离不当率、术后放疗过早率、术后加压包扎过紧率、术后切口敷料过厚率均显著高于未发生并发症组,差异均有统计学意义(P<0.05);经Logistic回归分析显示,手术切口选择不当、术中未彻底止血、腋窝清扫范围不合理、电刀应用不当、皮瓣游离不当、术后放疗过早、术后加压包扎过紧、术后切口敷料过厚是导致乳腺癌改良根治术并发症发生的影响因素。结论乳腺癌改良根治术并发症的发生原因较多,如手术切口选择不当、术中未彻底止血、腋窝清扫范围不合理、电刀应用不当、皮瓣游离不当等,为减少患者术后并发症的发生,临床医师术前应为患者选择恰当的手术切口,术中严格规范操作,术后对切口实施妥善包扎、处理等。

Objective To explore the causes and preventive measures of complications of modified radical mastectomy for breast cancer.Methods Altogether 60 cases of patients who underwent modified radical mastectomy in our hospital from January 2014 to December 2017 were selected as the observation object.The clinical data of 60 patients were analyzed retrospectively.Combined with the complications,all the patients were divided into complication group（23 cases）and non-complication group（37 cases）.The causes and preventive measures of complications of modified radical mastectomy for breast cancer were studied.Results The inappropriate surgical incision selection rate,incomplete intra-operative hemostasis rate,unreasonable axillary dissection rate,improper use of electric knife,improper free flap rate,post-operative premature radiotherapy,post-operative over-pressurized bandage rate,and post-operative over-thick incision dressings rate of complication group were significantly higher than those of non-complication group with statistically significant（P〈0.05）.Logistic regression analysis showed that influencing factors leading to complications of modified radical mastectomy for breast cancer included inappropriate surgical incision selection,incomplete intra-operative hemostasis,unreasonable axillary dissection,improper use of electric knife,improper free flap,post-operative premature radiotherapy,post-operative over-pressurized bandage and post-operative over-thick incision dressings.Conclusion There are many reasons for the complications of modified radical mastectomy,such as inappropriate surgical incision selection,incomplete intra-operative hemostasis,unreasonable axillary dissection,improper use of electric knife and improper free flap.The clinicians should choose appropriate surgical incision pre-operatively,act strictly in accordance with the standard intra-operatively and provide proper dressing treatment of incisions post-operatively so as to reduce the postoperative complications of the patients.