乳腺癌改良根治术后皮下积液的影响因素及防治策略

Influencing Factors and Prevention Strategies of Subcutaneous Effusion after Modified Radical Mastectomy

目的:探讨乳腺癌改良根治术后皮下积液发生的影响因素及预防治疗措施。方法:回顾性分析河南科技大学附属黄河医院2004年1月-2020年12月收治的806例乳腺癌改良根治术患者。采用单因素分析软件和Logistic多因素回归分析皮下积液发生的相关因素,统计皮下积液的处理情况。结果:术后发生皮下积液118例,发生率为14.6%。单因素分析结果显示,皮下积液患者年龄>45岁、无皮瓣固定、未使用生物蛋白胶、术前新辅助治疗及合并糖尿病比率高于无皮下积液患者,差异有统计学意义(P<0.05);多因素分析结果显示,年龄>45岁、无皮瓣固定、术前新辅助治疗及合并糖尿病等是乳腺癌患者术后皮下积液的危险因素,差异有统计学意义(P<0.05);87例皮下积液少于20 ml给予皮下穿刺抽吸,加压包扎,全部治愈;29例引流管拔出后皮下积液大于20 ml,给予重新置管引流,加压包扎,积液消失;2例顽固性皮下积液给予纤维板切除,术后负压引流,加压包扎后治愈,迁延病程长达3~6个月。结论:年龄>45岁、无皮瓣固定、术前新辅助治疗及合并糖尿病等是乳腺癌改良根治术后皮下积液的危险因素,临床应对患者进行全方位干预控制,预防皮下积液发生,提高治疗效果。

Objective:To investigate the factors influencing the occurrence of subcutaneous effusion after modified radical mastectomy and the prevention and treatment measures.Method:A retrospective analysis of 806 patients undergoing modified radical mastectomy in Huanghe Hospital Affiliated to Henan University of Science and Technology from January 2004 to December 2020 was performed.Single factor analysis software and Logistic multivariate regression were used to analyze the related factors of subcutaneous effusion.The treatment of subcutaneous effusion was counted.Result:There were 118 cases of subcutaneous effusion occurred after the operation,the incidence rate was 14.6%.Univariate analysis showed that age,the rate of age>45 years old,no flap fixation,no fibrin glue,neoadjuvant therapy before operation and complicated diabetes mellitus in patients with subcutaneous hydrops were significantly higher than those without subcutaneous hydrops,and the differences were statistically significant(P<0.05);multivariate analysis showed that age>45 years,no flap fixation,preoperative neoadjuvant therapy,and diabetes were the risk factors of postoperative subcutaneous fluid in breast cancer patients,and the differences were statistically significant(P<0.05);87 cases of subcutaneous effusion subcutaneous puncture and aspiration of fluid less than 20 ml,pressure bandaging,all cured;29 cases of subcutaneous fluid effusion after drainage tube pulled out greater than 20 ml,re-insertion tube drainage,pressure bandaging,fluid effusion disappeared;2 cases of refractory subcutaneous fluid were given to the fiberboard for resection,negative pressure drainage after the operation,and pressure bandaging to cure,the prolonged course of the disease was as long as 3-6 months.Conclusion:Age>45 years old,no flap fixation,neoadjuvant therapy before operation and diabetes mellitus are risk factors for postoperative subcutaneous effusion after modified radical mastectomy.All-round intervention and control should be carried out to prevent subcutaneous effusion and improve the therapeutic effect.