红色诺卡菌细胞壁骨架术中冲洗创面影响乳腺癌术后引流量的前瞻性研究

Prospective study on the effect of intraoperative flushing treatment with nocardia rubra cell-wall skeleton on drainage after mastectomy

目的 探讨红色诺卡菌细胞壁骨架(N-CWS)术中冲洗创面用于减少乳腺癌乳房全切除术后引流量和降低皮下积液发生率的有效性和安全性。方法 连续纳入2020年1~6月间在河北医科大学第四医院行乳房单纯切除术或改良根治术的女性乳腺癌病人145例,采用有放回的双色球抽签法随机选择40例分至试验组,在术中应用N-CWS 800μg+生理盐水50 mL进行切除术后的创口冲洗;其余105例分至对照组,仅用等量生理盐水冲洗创面。记录并比较两组病人术后0~24 h和>24~48 h的引流量、引流管置留天数、术后住院天数、手术相关并发症(切口感染、皮下积液和皮瓣坏死)发生率及其差异。结果 试验组病人的术后>24~48 h引流量、引流管置留时间和术后住院时间均显著少于对照组(P<0.05),术后0~24 h引流量差异无统计学意义(Z=-1.190,P=0.234)。试验组术后出现发热24例(60.0%),其比例大于对照组27例(25.7%,P<0.001),但两组病人中发热病例的发热时间差异无统计学意义(Z=-0.568,P=0.570)。对照组出现腋窝皮下积液1例(1.0%),两组均未见切口感染和皮瓣坏死。结论 乳腺癌乳房全切除术中应用N-CWS冲洗创面可显著减少术后引流量、引流管置留时间和住院时间,有效预防术后皮下积液,安全可行。

Objective skeleton(N-CWS) on wound drainage after mastectomy.Methods mastectomy with or without axillary lymph node dissection(ALND) consecutively admitted to the Fourth Hospital of Hebei Medical University from January 2020 to June 2020 were included. With two-color balls sampling with replacement, a total of 40 patients were randomly arranged into the intervention group undergoing intraoperative flushing treatment with N-CWS 800μg in 50mL saline solution. The rest of 105 patients were arranged into the control group with intraoperative flushing treatment with the same amount of normal sodium. The drainage volume during 0~24h and >24~48h after surgery, the duration of drainage tube indwelling, hospital stays, surgery-related complications including incision infection, subcutaneous hydrops and skin flap necrosis were recorded and compared between the two groups.Results The drainage volume during >24~48h postoperatively, the duration of drainage tube indwelling and hospital stays in the intervention group were significantly less than that in the control group(P<0.05), while the difference in the drainage volume during 0~24h postoperatively between the two groups were not significant(z=-1.190, P=0.234). Twentyfour(60.0%) patients in the intervention group developed fever, in which the proportion was more than twenty-seven of the control group(25.7%, P<0.001). However, there was no difference in the duration of fever between the two groups(z=-0.568, P=0.570). There was 1 patient(1.0%) developing axillary seroma in the control group. Incision infection and skin flap necrosis were not observed in both groups.ConclusionIntraoperative flushing treatment with N-CWS was able to reduce the postoperative drainage volume and hospital stays and prevent the seroma effectively after breast cancer mastectomy, which was safe and feasible.