负压封闭引流技术在乳腺切除皮瓣移植术中同期应用的效果分析

Analysis of the effect of vacuum sealing drainage on simultaneous breast flap transplantation

目的探讨乳腺切除皮瓣移植术中同期应用负压封闭引流技术的临床效果。方法选择2014年1月至2016年6月首都医科大学附属北京世纪坛医院收治的62例女性乳腺癌患者为研究对象,采用随机数表法将入选患者分为研究组和对照组,每组各31例。所有患者均采用乳腺癌改良根治术切除乳腺,乳腺切除后所有患者均选用腹部皮肤作为皮瓣来源进行自体皮瓣移植术。对照组患者采用无菌纱布敷于创面,常规引流换药,定期查看伤口状况并及时更换敷料;研究组患者皮瓣移植术后采用负压封闭引流技术进行持续引流,负压治疗7~10天后拆除敷料。记录并比较两组患者的手术时间、伤口愈合时间、住院天数、皮瓣坏死率、二次皮瓣移植率、皮瓣坏死程度、不良反应发生情况及患者对伤口愈合程度和美观性的满意度。结果两组患者手术时间比较无显著差异(P>0.05),研究组患者伤口愈合时间和住院天数均显著短于对照组(P均<0.05),术后皮瓣坏死率、二次皮瓣移植率、术后总不良反应发生率及皮瓣坏死程度均显著低于对照组(P均<0.05),患者对伤口愈合程度和美观性的满意度显著高于对照组(P<0.05)。结论乳腺切除皮瓣移植术中同期应用负压封闭引流技术,能有效降低乳腺切除后皮瓣移植的坏死率、二次皮瓣移植率及术后不良反应发生率,减轻皮瓣坏死程度,缩短患者住院天数,提高患者满意度,值得临床推广。

Objective To investigate the clinical effect of vacuum sealing drainage on simultaneous breast flap transplantation. Method From January 2014 to June 2016, 62 cases of female patients diagnosed with breast cancer in Beijing Shijitan Hospital Affiliated to Capital Medical University were selected as research objects, they were randomly divided into study group and control group, 31 cases in each group, all patients underwent modified radical mastectomy for breast resection. After mastectomy, all patients used the abdominal skin flap as the source of skin flap. Patients in control group were treated with sterile gauze on the wound surface, routine drainage, dressing change, regular examination of the wound condition, and timely replacement of dressings; study group patients underwent vacuum sealing drainage for continuous drainage after skin flap transplantation, the dressing was removed after 7 ~ 10 days. The operation time, the wound healing time, the hospitalization time, the rate of necrosis of the flap, second transplanting rate of skin flap, the degree of necrosis of the flap, the occurrence of adverse reaction and the satisfaction of patients on the degree of wound healing and the beauty of the two groups were recorded and compared. Result The operation time had no significant difference between the two groups（P〉0.05）. The wound healing time and hospitalization time in study group were significantly shorter than those in control group（Pall〈 0.05）, the rate of necrosis of the flap, second transplanting rate of skin flap in study group, the occurrence of adverse reaction after operation and the degree of necrosis of the skin flap in study group were significantly lower than those in control group（Pall〈 0.05）, the satisfaction of patients on the degree of wound healing and the beauty in study group were significantly higher than those in control group（P〈0.05）. Conclusion Vacuum sealing drainage can effectively reduce the rate of necrosis of the flap, second transplanting rate of skin flap and the occurrence of adverse reaction after operation, reduce the degree of necrosis of the skin flap, shorten the hospitalization time and improve the patient＇s satisfaction. It is worthy of clinical promotion.