乳腺癌改良根治术后胸前和腋下置管时间危险因素研究

Risk factors influencing time of anterior chest and axillary catheterization after modified radical mastectomy for breast cancer

目的探讨乳腺癌改良根治术后胸前和腋下置管时间的影响因素。方法选取2018年9月至2019年12月间陕西中医药大学第二附属医院收治的136例行乳腺癌改良根治术的患者,采用单因素和多因素分析临床病理资料对患者术后胸前和腋下置管时间的影响。结果术后,患者胸前置管时间为2~19(7.5±2.9)天,中位7天;腋下置管时间为4~22(10.4±3.3)天,中位10天。术后并发症发生情况:皮下积液18例,皮瓣坏死1例,出血1例,伤口感染4例。单因素分析结果显示,患者年龄、体质量指数(BMI)、高血压、冠心病、糖尿病、TNM分期、腋窝淋巴结手术、淋巴结清扫数目、术后并发症和负压引流方式均会影术后胸前置管时间,差异均有统计学意义(均P<0.05);BMI、高血压、冠心病、糖尿病、TNM分期、腋窝淋巴结手术、淋巴结清扫数目、术后并发症和负压引流方式均会影响患者术后腋下置管时间,差异均有统计学意义(均P<0.05)。患者高血压、糖尿病、术后并发症和负压引流方式是患者术后胸前置管时间的独立影响因素,差异均有统计学意义(均P<0.05)。患者BMI、高血压、术后并发症和负压引流方式是患者术后腋下置管时间的独立影响因素,差异均有统计学意义(均P<0.05)。结论高血压、术后并发症及负压引流方式是乳腺癌改良根治术患者术后胸前和腋下置管时间的影响因素,临床应对高血压和术后发生并发症的患者加强围术期管理,选择合适的负压引流方式。

Objective To investigate the factors influencing anterior chest and axillary placement time in patients who underwent modified radical mastectomy for breast cancer.Methods Clinical data of136 patients with breast cancer undergoing modified radical mastectomy were collected at The Second Affiliated Hospital of Shaanxi University of Chinese Medicine from September 2018 to December 2019.Univariate and multivariate analysis were used to analyze the effects of clinical data on anterior chest and axillary placement time.Results After the operation,anterior chest placement time was 2 to 19(7.5±2.9)d with median time of 7 d.Axillary placement time was 4 to 22(10.4±3.3)d with median time of 10 d.In terms of postoperative complications,seroma occurred in 18 patients,skin flap necrosis 1 patient,blood loss 1 patient,and wound infection 4 patients.Univariate analysis showed that age,body mass index(BMI),hypertension,coronary heart disease,diabetes,tumor,node and metastases(TNM)stage,axillary lymph node surgery,number of lymph node dissected,postoperative complications and negative pressure drainage mode had an effect on postoperative anterior chest catheterization time(all P<0.05).BMI,hypertension,coronary heart disease,diabetes,TNM stage,postoperative complications and negative pressure drainage mode had an effect on the postoperative axillary catheterization time(all P<0.05).Hypertension,diabetes,postoperative complications and negative pressure drainage mode were independent factors influencing anterior chest placement time(all P<0.05).BMI,hypertension,postoperative complications,and negative pressure drainage mode were independent factors influencing the postoperative axillary catheterization time.Conclusion Hypertension,postoperative complications and negative pressure drainage are factors influencing postoperative catheter placement time in breast cancer patients undergoing modified radical mastectomy.Perioperative management should be strengthened in patients with hypertension and postoperative complications,and appropriate negative pressure drainage method should be selected.