乳腺癌改良根治术后出血的危险因素分析及防治对策

Analysis of Risk Factors and Prevention of Bleeding After Mastectomy for Breast Cancer

目的:分析乳腺癌改良根治术后出血的因素,探讨其原因及预防措施,降低乳腺癌术后出血的发生风险。方法:回顾性分析我院2011年1月至2018年5月收治的425例改良乳房根治术患者中22例术后出血的临床资料,统计术后出血并发症的发生率,并探讨预防该并发症的对策。结果:22例患者中,12例使用高负压引流瓶,14例患者行术前新辅助化疗,3例术后6小时引流量大于200 ml。5例患者长期口服抗高血压药物,1例患者长期服用抗抑郁药物。13例行急诊手术止血,另9例行调整吸引的负压强度,同时弹力绷带压迫止血,均治愈。22例均无皮瓣坏死,仅1例出现局部创面感染。结论:高负压吸引装置,术前新辅助化疗,高血压是乳腺改良根治术后出血的高危因素,围手术期进行严密的监测,使用适当的负压吸引,合理的使用止血药物都能够降低术后出血的风险。

Objective:To analyze the factors of bleeding after modified radical mastectomy for breast cancer,explore its causes and preventive measures,and reduce the risk of bleeding after breast cancer surgery.Methods:The clinical data of 22 patients with postoperative bleeding from 425 patients with modified radical mastectomy admitted in our hospital from January 2011 to may 2018 were retrospectively analyzed,the incidence of postoperative bleeding complications was counted,and the countermeasures to prevent the complications were discussed.Results:Among the 22patients,12 patients used high negative pressure drainage bottles,14 patients received preoperative neoadjuvant chemotherapy,and 3 patients had a drainage volume of more than 200ml 6 hours after operation. Five patients took antihypertensive drugs for a long time,and one patient took antidepressants for a long time. 13 cases underwent emergency operation for hemostasis,and the other 9 cases were cured by adjusting the negative pressure intensity of suction and compression with elastic bandage. There was no flap necrosis in 22 cases,only 1 case had local wound infection.Conclusion:High negative pressure suction device,preoperative neoadjuvant chemotherapy and hypertension are the highrisk factors of postoperative bleeding after modified radical mastectomy. The risk of postoperative bleeding can be reduced by strict monitoring,proper negative pressure suction and rational use of hemostatic drugs during the perioperative period.