• 四川省腫瘤醫(yī)院乳腺外科(成都 610041);

目的 探討超聲刀聯(lián)合腋窩處皮膚外固定預(yù)防乳腺癌改良根治術(shù)后皮下積液的效果。方法 回顧性分析我院2009年5~11月期間166例行乳腺癌改良根治術(shù)患者的手術(shù)資料,其中51例術(shù)中采用超聲刀聯(lián)合腋窩處皮膚外固定技術(shù)(聯(lián)合組),52例術(shù)中采用腋窩處皮膚外固定技術(shù)(外固定組),63例患者為常規(guī)組。比較3組患者手術(shù)時(shí)間、術(shù)中出血量、術(shù)中副損傷、術(shù)后引流量、引流管留置時(shí)間、淋巴結(jié)檢出數(shù)目和皮下積液的發(fā)生情況。結(jié)果 3組患者手術(shù)時(shí)間及淋巴結(jié)檢出數(shù)目的差異無(wú)統(tǒng)計(jì)學(xué)意義(P gt;0.05),均無(wú)血管、神經(jīng)副損傷。聯(lián)合組術(shù)中出血量明顯少于外固定組和常規(guī)組(P lt;0.05)。常規(guī)組、外固定組和聯(lián)合組患者術(shù)后引流量及引流管留置時(shí)間依次減少或縮短,3組間兩兩比較差異均有統(tǒng)計(jì)學(xué)意義(P lt;0.05)。 聯(lián)合組患者術(shù)后皮下積液發(fā)生率低于常規(guī)組(P lt;0.05)。結(jié)論 應(yīng)用超聲刀行乳腺癌手術(shù)安全、可行,具有創(chuàng)傷小、術(shù)中出血少等優(yōu)點(diǎn),聯(lián)合腋窩處皮膚外固定能顯著減少皮下積液的發(fā)生率,有利于皮瓣的愈合。

引用本文: 田超,李卉. 新型超聲刀聯(lián)合腋窩處皮膚外固定在乳腺癌手術(shù)中的應(yīng)用. 中國(guó)普外基礎(chǔ)與臨床雜志, 2010, 17(12): 1245-1248. doi: 復(fù)制

1. Han J, Grothuesmann D, Neises M, et al. Quality of life and satisfaction after breast cancer operation [J]. Arch Gynecol Obstet, 2010; 282(1): 75-82.
2. Kashiwaba M, Inaba T, Takeda Y, et al. The ideal follow-up after breast cancer operation [J]. Gan To Kagaku Ryoho, 2009; 36(9): 1423-1427.
3. 許曉松, 姜軍, 吳超, 等. 多點(diǎn)固定縫合皮瓣與胸壁控制乳腺癌術(shù)后皮下積液 [J]. 中國(guó)廠礦醫(yī)學(xué), 2008; 21(1): 3.
4. 任兆增, 王壽強(qiáng), 劉進(jìn)健, 等. 皮瓣固定在乳腺癌根治術(shù)中的應(yīng)用 [J]. 中國(guó)現(xiàn)代普通外科進(jìn)展, 2003; 4(1): 54.
5. 康華峰, 王西京, 劉小旭, 等. 皮瓣?duì)坷?、固定預(yù)防乳腺癌手術(shù)后皮下積液和皮緣壞死 [J]. 陜西醫(yī)學(xué)雜志, 2005; 34(12): 1493-1495, 1497. .
6. Koyama H. Operation for breast cancers [J]. Nippon Rinsho, 2000; 58 Suppl: 168-172.
7. 左文述. 現(xiàn)代乳腺腫瘤病學(xué) [M]. 第2版. 山東: 山東科學(xué)技術(shù)出版社, 2006: 735-749.
8. 周蘭蘭. 鎖骨固定帶在乳腺癌根治術(shù)后防治腋窩皮下積液中的應(yīng)用 [J]. 中國(guó)全科醫(yī)學(xué), 2009; 12(3B): 499-500.
9. 李建軍, 李士秋, 程勇, 等. 皮瓣多點(diǎn)固定預(yù)防乳腺癌術(shù)后皮下積液的應(yīng)用價(jià)值 [J]. 中國(guó)醫(yī)藥, 2007; 2(10): 624-626.
10. Schinagl DA, van Tienhoven G. Breast cancer: disentangling the intricate Web [J]. J Clin Oncol, 2010; 28(17): e281.
11. Elkhuizen PH, van Slooten HJ, Clahsen PC, et al. High Local recurrence risk after breast-conserving therapy in node-negative premenopausal breast cancer patients is greatly reduced by one course of perioperative chemotherapy: A European Organization for Research and Treatment of Cancer Breast Cancer Cooperative Group Study [J]. J Clin Oncol, 2000; 18(5): 1075-1083.
12. Autier P, Héry C, Haukka J, et al. Advanced breast cancer and breast cancer mortality in randomized controlled trials on mammography screening [J]. J Clin Oncol, 2009; 27(35): 5919-5923.
13. Anderson SJ, Wapnir I, Dignam JJ, et al. Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in patients treated by breast-conserving therapy in five National Surgical Adjuvant Breast and Bowel Project protocols of node-negative breast cancer [J]. J Clin Oncol, 2009; 27(15): 2466-2473.
14. Chlebowski RT, Anderson G, Manson JE, et al. Estrogen alone in postmenopausal women and breast cancer detection by means of mammography and breast biopsy [J]. J Clin Oncol, 2010; 28(16): 2690-2697.
15. Gilligan MA, Neuner J, Zhang X, et al. Relationship between number of breast cancer operations performed and 5-year survival after treatment for early-stage breast cancer [J]. Am J Public Health, 2007; 97(3): 539-544.
16. Niehoff P, Ballardini B, Polgár C, et al. Early European experience with the MammoSite radiation therapy system for partial breast brachytherapy following breast conservation operation in low-risk breast cancer [J]. Breast, 2006; 15(3): 319-325.
17. 胡建昆, 張波, 陳心足, 等. 新型超聲刀在胃癌根治術(shù)中的應(yīng)用及技巧 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2008; 15(10): 718-721.
18. 周洪偉, 曾曉華, 余永康, 等. 超聲刀在乳腺癌根治術(shù)中的臨床應(yīng)用研究 [J]. 臨床超聲醫(yī)學(xué)雜志, 2004; 6(4): 213-215.
19. 劉春萍, 石嵐, 程波, 等. 超聲刀與電刀在乳腺癌手術(shù)治療中應(yīng)用效果比較 [J]. 華中醫(yī)學(xué)雜志, 2005; 29(6): 455-456.
20. Husen M, Paaschburg B, Flyger HL. Two-step axillary operation increases risk of arm morbidity in breast cancer patients [J]. Breast, 2006; 15(5): 620-628.
21. 韋尉東, 王欣, 戎鐵華, 等. 乳腺癌手術(shù)保留肋間臂神經(jīng)的方法及臨床意義 [J]. 中華外科雜志, 2005; 43(17): 1136-1138.
22. Hongying WU, Shan ZC, Thakuri B. Origin and countermeasure for common skin flap complications after radical operation for breast cancer [J]. Kathmandu Univ Med J (KUMJ), 2006; 4(1): 14-17.
23. Krki A, Simonen R, Mlki E, et al. Impairments, activity limitations and participation restrictions 6 and 12 months after breast cancer operation [J]. J Rehabil Med, 2005; 37(3): 180-188.
  1. 1. Han J, Grothuesmann D, Neises M, et al. Quality of life and satisfaction after breast cancer operation [J]. Arch Gynecol Obstet, 2010; 282(1): 75-82.
  2. 2. Kashiwaba M, Inaba T, Takeda Y, et al. The ideal follow-up after breast cancer operation [J]. Gan To Kagaku Ryoho, 2009; 36(9): 1423-1427.
  3. 3. 許曉松, 姜軍, 吳超, 等. 多點(diǎn)固定縫合皮瓣與胸壁控制乳腺癌術(shù)后皮下積液 [J]. 中國(guó)廠礦醫(yī)學(xué), 2008; 21(1): 3.
  4. 4. 任兆增, 王壽強(qiáng), 劉進(jìn)健, 等. 皮瓣固定在乳腺癌根治術(shù)中的應(yīng)用 [J]. 中國(guó)現(xiàn)代普通外科進(jìn)展, 2003; 4(1): 54.
  5. 5. 康華峰, 王西京, 劉小旭, 等. 皮瓣?duì)坷⒐潭A(yù)防乳腺癌手術(shù)后皮下積液和皮緣壞死 [J]. 陜西醫(yī)學(xué)雜志, 2005; 34(12): 1493-1495, 1497. .
  6. 6. Koyama H. Operation for breast cancers [J]. Nippon Rinsho, 2000; 58 Suppl: 168-172.
  7. 7. 左文述. 現(xiàn)代乳腺腫瘤病學(xué) [M]. 第2版. 山東: 山東科學(xué)技術(shù)出版社, 2006: 735-749.
  8. 8. 周蘭蘭. 鎖骨固定帶在乳腺癌根治術(shù)后防治腋窩皮下積液中的應(yīng)用 [J]. 中國(guó)全科醫(yī)學(xué), 2009; 12(3B): 499-500.
  9. 9. 李建軍, 李士秋, 程勇, 等. 皮瓣多點(diǎn)固定預(yù)防乳腺癌術(shù)后皮下積液的應(yīng)用價(jià)值 [J]. 中國(guó)醫(yī)藥, 2007; 2(10): 624-626.
  10. 10. Schinagl DA, van Tienhoven G. Breast cancer: disentangling the intricate Web [J]. J Clin Oncol, 2010; 28(17): e281.
  11. 11. Elkhuizen PH, van Slooten HJ, Clahsen PC, et al. High Local recurrence risk after breast-conserving therapy in node-negative premenopausal breast cancer patients is greatly reduced by one course of perioperative chemotherapy: A European Organization for Research and Treatment of Cancer Breast Cancer Cooperative Group Study [J]. J Clin Oncol, 2000; 18(5): 1075-1083.
  12. 12. Autier P, Héry C, Haukka J, et al. Advanced breast cancer and breast cancer mortality in randomized controlled trials on mammography screening [J]. J Clin Oncol, 2009; 27(35): 5919-5923.
  13. 13. Anderson SJ, Wapnir I, Dignam JJ, et al. Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in patients treated by breast-conserving therapy in five National Surgical Adjuvant Breast and Bowel Project protocols of node-negative breast cancer [J]. J Clin Oncol, 2009; 27(15): 2466-2473.
  14. 14. Chlebowski RT, Anderson G, Manson JE, et al. Estrogen alone in postmenopausal women and breast cancer detection by means of mammography and breast biopsy [J]. J Clin Oncol, 2010; 28(16): 2690-2697.
  15. 15. Gilligan MA, Neuner J, Zhang X, et al. Relationship between number of breast cancer operations performed and 5-year survival after treatment for early-stage breast cancer [J]. Am J Public Health, 2007; 97(3): 539-544.
  16. 16. Niehoff P, Ballardini B, Polgár C, et al. Early European experience with the MammoSite radiation therapy system for partial breast brachytherapy following breast conservation operation in low-risk breast cancer [J]. Breast, 2006; 15(3): 319-325.
  17. 17. 胡建昆, 張波, 陳心足, 等. 新型超聲刀在胃癌根治術(shù)中的應(yīng)用及技巧 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2008; 15(10): 718-721.
  18. 18. 周洪偉, 曾曉華, 余永康, 等. 超聲刀在乳腺癌根治術(shù)中的臨床應(yīng)用研究 [J]. 臨床超聲醫(yī)學(xué)雜志, 2004; 6(4): 213-215.
  19. 19. 劉春萍, 石嵐, 程波, 等. 超聲刀與電刀在乳腺癌手術(shù)治療中應(yīng)用效果比較 [J]. 華中醫(yī)學(xué)雜志, 2005; 29(6): 455-456.
  20. 20. Husen M, Paaschburg B, Flyger HL. Two-step axillary operation increases risk of arm morbidity in breast cancer patients [J]. Breast, 2006; 15(5): 620-628.
  21. 21. 韋尉東, 王欣, 戎鐵華, 等. 乳腺癌手術(shù)保留肋間臂神經(jīng)的方法及臨床意義 [J]. 中華外科雜志, 2005; 43(17): 1136-1138.
  22. 22. Hongying WU, Shan ZC, Thakuri B. Origin and countermeasure for common skin flap complications after radical operation for breast cancer [J]. Kathmandu Univ Med J (KUMJ), 2006; 4(1): 14-17.
  23. 23. Krki A, Simonen R, Mlki E, et al. Impairments, activity limitations and participation restrictions 6 and 12 months after breast cancer operation [J]. J Rehabil Med, 2005; 37(3): 180-188.