乳房切除术后3种皮瓣处理的效果评价

doi:10.3969/j.issn.1009-976X.2022.02.005

摘要/Abstract

摘要： 目的评价乳腺癌乳房切除术后3种皮瓣处理的结果。方法收集2019年2月至2021年4月在我院进行全乳房切除术或改良根治术的108例乳腺癌患者的临床资料。根据处理皮瓣的不同分为常规缝合（A组,n=30）;缝合线皮瓣固定（B组,n=42）;医用组织胶皮瓣固定（C组,n=36）,所有患者进行至少6月术后随访评价,记录入组患者基本资料、血清肿形成及处理,血清肿伴发其他并发症、随访资料包括引流、手术部位感染、门诊次数、皮瓣坏死、再手术、疼痛、美容效果及术后放化疗和激素治疗。结果总共20例患者发生需要穿刺处理的血清肿,均发生在接受腋窝淋巴结清扫患者中,其中A组7例（23.3%）、B组7例（7.3%）、C组6例（16.6%）,尽管A组占比高于B组和C组,但三组间发生例数没有统计学意义。三组之间在术后引流量、术后疼痛、手术部位感染例数、再住院病例、术后门诊关于切口创面附加处理就诊没有显着差异,也没有观察到肩部功能的差异;随访6月结果也没有观察到三种方法对皮肤美容的显着差异。结论在乳腺癌手术皮瓣处理的方法中,常规闭合切口、缝合线皮瓣固定和使用医用组织胶对于防止血清肿的形成没有明显的差别,这可能与术后腋窝引流充分以及良好的压迫有关。

关键词: 乳房切术, 血清肿, 皮瓣处理

Abstract: Objective To evaluate the results of three kinds of flap treatments after breast cancer mastectomy. Methods 108 patients with breast cancer from February 2019 to April 2021 were were allocated to one of the three following groups according to flap fixation： conventional wound closure （A group, n=30）, flap fixation using sutures （B group,n=42） or flap fixation using tissue glue （C group, n=36）. And all patients underwent total mastectomy or modified radical mastectomy and followed up for at least 6 months after surgery. The basic information, the formation and treatment of seromas, and other complications associated with seromas were recorded and analyzed among patients. Also, the secondary outcomes were observed such as drainage, surgical site infections, outpatient visits, flap necrosis, reoperations, postoperative pain score, cosmetic effects and further treatment after surgery. Results A total of 20 patients had seromas that required puncture treatment, all of which occurred in patients receiving axillary lymph node dissection, including 7 cases in group A （23.3%）, 7 cases in group B （7.3%）, and 6 cases in group C （16.6%）. Although the proportion of group A was higher than that of group B and group C, the number of cases among the three groups was not statistically significant. There were no significant differences in postoperative drainage, postoperative pain, surgical site infection, rehospitalization, and postoperative outpatient visits for additional treatment of incision wounds, and no differences in shoulder function were observed; no significant difference in skin beauty between the three methods was observed in six month follow-up. Conclusion In th present study, there was no obvious difference between conventional closed incisions, suture flap fixation and the use of medical tissue glue to prevent the formation of seromas, which may be related to adequate postoperative axillary drainage and good flap compression.

Key words: mastectomy, seroma formation, flap fixation

中图分类号:

R655.8

何文君, 洪泓, 梁素琼, 黄丽芳. 乳房切除术后3种皮瓣处理的效果评价[J]. 岭南现代临床外科, 2022, 22(02): 138-142.

HE Wen-jun, HONG Hong, LIANG Su-qiong, HUANG Li-fang. Evaluation of three kinds of flap treatments after mastectomy[J]. Lingnan Modern Clinics In Surgery, 2022, 22(02): 138-142.

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