乳腺癌术后早期引流量对引流管带管时间预测作用探讨

Exploration of predictive function on early postoperative drainage volume for indwelling time of drainage tube in patients with breast cancer

目的探讨乳腺癌患者术后引流量的影响因素并分析早期引流量对胸骨旁及腋窝引流管带管时间的预测作用。方法收集2020-01-01-2020-12-31山东第一医科大学附属山东省肿瘤医院乳腺外科接受乳腺癌手术的345例患者的临床资料,每日记录胸骨旁和腋窝引流管的引流量和带管时间。分别以胸骨旁平均带管天数和腋窝平均带管天数进行分组,采用单因素和多因素回归分析影响胸骨旁和腋窝引流管带管时间的危险因素,评估术后前3 d引流量与引流管带管时间的相关性。结果胸骨旁引流管平均带管时间为(5.34±2.13)d,腋窝引流管平均带管时间为(7.78±3.44)d。单因素分析结果显示,手术方式(χ^(2)=4.618,P=0.032)、TNM分期(χ^(2)=8.739,P=0.003)、体质量指数(BMI,χ^(2)=9.816,P=0.002)和感染(χ^(2)=5.614,P=0.018)与引流管带管时间长短有关,差异有统计学意义;肿瘤位置(χ^(2)=4.921,P=0.027)、手术方式(χ^(2)=18.617,P<0.001)、TNM分期(χ^(2)=12.853,P<0.001)、BMI(χ^(2)=46.971,P<0.001)和感染(χ^(2)=5.289,P=0.021)与腋窝引流管带管时间长短有关,差异有统计学意义。logistic多因素回归分析结果显示,新辅助化疗(OR=0.504,95%CI为0.256~0.992,P=0.047)、TNM分期(OR=1.410,95%CI为1.082~1.837,P=0.011)、BMI(OR=1.941,95%CI为1.225~3.077,P=0.005)和感染(OR=2.721,95%CI为1.051~7.044,P=0.039)是影响胸骨旁引流管带管时间的独立危险因素;肿瘤位置(OR=0.545,95%CI为0.333~0.892,P=0.016)、手术方式(OR=2.155,95%CI为1.160~4.003,P=0.015)、TNM分期(OR=1.445,95%CI为1.051~1.986,P=0.023)和BMI(OR=6.216,95%CI为3.517~10.986,P<0.001)是影响腋窝引流管带管时间的独立危险因素。术后第1天,胸骨旁带管时间≤5.35 d患者引流量为20(30)mL,低于>5.35 d患者的30(30)mL,Z=-3.033,P<0.001;术后第2天,胸骨旁带管时间≤5.35 d患者引流量为20(25)mL,低于>5.35 d患者的40(30)mL,Z=-4.688,P<0.001;术后第3天,胸骨旁带管时间≤5.35 d患者引流量为10(10)mL,低于>5.35 d患者的30(30)mL,Z=-11.084,P<0.001。术后第1天,腋窝带管时间≤7.83 d患者引流量为50(40)mL,低于>7.83 d患者的70(60)mL,Z=-4.120,P<0.001;术后第2天,腋窝带管时间≤7.83 d患者引流量为50(50)mL,低于>7.83 d患者的80(70)mL,Z=-6.235,P<0.001;术后第3天,腋窝带管时间≤7.83 d患者引流量为40(40)mL,低于>7.83 d患者的70(60)mL,Z=-6.810,P<0.001。结论乳腺癌患者TNM分期晚、BMI大、术后前3 d引流量多的患者术后带管时间较长,需要重点关注。

Objective To explore the influencing factors of postoperative drainage volume in patients with breast cancer and analyze the predictive value of early drainage volume on the duration of peristernal and axillary drainage tubes.Methods The clinicopathologic data of 345patients who underwent breast cancer surgery in the Department of Breast Surgery,Shandong Cancer Hospital Affiliated to Shandong First Medical University from January 1to December 31,2020were collected.The drainage volume and indwelling time of parastrasternal and axillary drainage tubes were recorded daily.The average days of parastrasternal drainage and axillary drainage were divided into groups.Univariate and multivariate regression analysis were used to analyze the risk factors affecting the indwelling time of parastrasternal and axillary drainage tubes,and the correlation between drainage volume in the first 3days after surgery and indwelling time were evaluated.Results The average duration of parastnal drainage tube was(5.34±2.13)d,and the average duration of axillary drainage tube was(7.78±3.44)d.Univariate analysis showed that surgical method(χ^(2)=4.618,P=0.032),TNM stage(χ^(2)=8.739,P=0.003),body mass index(BMI,χ^(2)=9.816,P=0.002)and infection(χ^(2)=5.614,P=0.018)were related to the indwelling time of the parastrasternal drainage tube.The differences were statistically significant.Tumor location(χ^(2)=4.921,P=0.027),surgical method(χ^(2)=18.617,P<0.001),TNM stage(χ^(2)=12.853,P<0.001),BMI(χ^(2)=46.971,P<0.001),and infection(χ^(2)=5.289,P=0.021)were related to the indwelling time of axillary drainage tube,and the differences were statistically significant.Logistic multivariate regression analysis showed that neoadjuvant chemotherapy(OR=0.504,95%CI:0.256-0.992,P=0.047),TNM staging(OR=1.410,95%CI:1.082-1.837,P=0.011),BMI(OR=1.941,95%CI:1.225-3.077,P=0.005)and infection(OR=2.721,95%CI:1.051-7.044,P=0.039)were independent risk factors for the indwelling time of parastural drainage.Tumor location(OR=0.545,95%CI:0.333-0.892,P=0.016),surgical method(OR=2.155,95%CI:1.160-4.003,P=0.015),TNM stage(OR=1.445,95%CI:1.051-1.986,P=0.023)and BMI(OR=6.216,95%CI:3.517-10.986,P<0.001)were independent risk factors for the indwelling time of axillary drainage.On the first day after surgery,the drainage volume of patients with parastural indwelling timeⅢ≥5.35days was 20(30)ml,lower than that of patients with>5.35days 30(30)ml,Z=-3.033,P<0.001.On the second day after surgery,the drainage volume of patients with parastural indwelling time≤5.35days was 20(25)ml,lower than that of patients with>5.35days 40(30)ml,Z=-4.688,P<0.001.On the third day after surgery,the drainage volume of patients with parastural indwelling time≤5.35days was 10(10)ml,lower than that of patients with>5.35days 30(30)ml,Z=-11.084,P<0.001.On the first day after surgery,the drainage volume of patients with axillary indwelling time≤7.83days was 50(40)ml,lower than that of patients with>7.83days 70(60)ml,Z=-4.120,P<0.001.On the second day after surgery,drainage volume in patients with axillary indwelling time≤7.83days was 50(50)ml,lower than that in patients with axillary indwelling time>7.83days 80(70)ml,Z=-6.235,P<0.001.On the third day after surgery,the drainage volume of patients with axillary indwelling time≤7.83days was 40(40)ml,lower than that in patients with axillary indwelling time>7.83days 70(60)ml,Z=-6.810,P<0.001.Conclusion Breast cancer patients with late TNM staging,large BMI,and large drainage volume in the first 3days after surgery have longer postoperative indwelling time,which requires more attention.