乳腺癌术后皮下积液的危险因素分析及相关防治方法

Risk factors of seroma formation in breast surgery and its prevention and treatment methods

目的 分析乳腺癌术后皮下积液发生的危险因素,并探讨相关的预防措施及治疗方法.方法 收集湖南省人民医院2016年1-9月收治的92例乳腺癌改良根治术患者的临床病例资料,分析乳腺癌术后积液形成与患者年龄、肿瘤大小、淋巴结转移数目、淋巴结清扫数目、皮瓣固定、加压包扎等的相关性.计数资料采用频数和百分数表示,组间比较采用x2检验.多因素分析采用Logistic回归分析.结果 92例患者乳腺癌改良根治术术后皮下积液发病率为45.7％(42/92).单因素分析提示,影响术后积液的相关因素分别为:年龄、肿瘤大小、淋巴结转移数目、淋巴结清扫数目、皮瓣固定;多因素分析显示,影响术后积液的因素为:淋巴结清扫数目(OR=1.123,95％CI:1.036 ～1.218,P＜0.01)、年龄(OR=1.060,95％ CI:1.006～1.116,P＜0.05)、皮瓣固定(OR=0.363,95％CI:0.135 ～0.977,P＜0.05).结论 年龄较大、腋窝清扫范围较广的患者更容易形成皮下积液,术中行皮瓣固定能减少术后皮下积液的发生.

Objective To identify risk factors for seroma formation and to explore the related prevention and treatment methods.Methods We collected clinical and pathological data of 92 breast cancer patients undergoing modified radical mastectomy in Hu'nan Provincial People's Hospital,from January to September 2016.Seroma formation was studied in relation to age,tumor size,nodal involvement,the number of lymph nodes removed,flap fixation and external compression dressing.Count date were evaluated by the frequency and percentage,comparison between the groups was analyzed by the chi-square test.Multivariate analysis was performed using Logistic regression analysis.Results Seroma occurred in 45.7％ of patients.Age,tumor size,nodal involvement,the number of lymph nodes removed,flap fixation were risk factors of modified radical mastectomy postoperative seroma.In multivariate logistic regression analysis an association of postoperative seroma formation was noted with the number of lymph nodes removed(OR =1.123,95％ CI:1.036-1.218,P ＜ 0.01),age(OR =1.060,95％ CI:1.006-1.116,P＜0.05),flap fixation(OR=0.363,95％CI:0.135-0.977,P ＜0.05).Conclusion The findings suggest that older patients,with extensive lymph node dissection may more likely to form postoperative seroma,flap fixation can reduce the incidence of seroma.