【摘要】 目的 比較在乳腺癌Auchincloss改良根治術中使用超聲刀及電刀手術的優(yōu)、缺點。 方法 2009年6月－2010年7月將176例乳腺癌患者通過信封法隨機分為超聲刀組和電刀組，每組88例，分別比較兩組患者手術時間、術中出血量、淋巴結(jié)檢出數(shù)目、術后引流量、皮下積液及術后出血量的差異。 結(jié)果 手術時間:超聲刀組為（145.72±50.76） min，電刀組為（171.27±66.68） min，兩組差異有統(tǒng)計學意義（P=0.005）；術中出血量:超聲刀組為（71.56±31.34） mL，電刀組為（84.99±36.39） mL，兩組差異有統(tǒng)計學意義（P=0.009）；清掃出的淋巴結(jié)個數(shù):超聲刀組為（20.92±9.09）個，電刀組為（17.90±6.74）個，兩組差異有統(tǒng)計學意義（P=0.013）。而在術后平均引流量和術后積液例數(shù)方面兩組的差異無統(tǒng)計學意義（P gt;0.05）。兩組均無術后出血的情況。 結(jié)論 在乳腺癌Auchincloss改良根治術中使用超聲刀，較單獨使用電刀能縮短手術時間，減少出血量，并增加淋巴結(jié)檢出的數(shù)量。
【Abstract】 Objective To compare the disadvantages and advantages between modified radical mastectomy with harmonic scalpel (HS) and conventional electro-scalpel (ES) for patients with breast cancer. Methods Between June 2009 and July 2010, 176 patients with breast cancer were randomly divided into two groups including the HS group and the ES group. The operation time, intra-operative bleeding volume, the number of lymph nodes detected, postoperative drainage volume, subcutaneous hydrops, and postoperative hemorrhage volume between the two groups of patients were compared. Results There were significant differences between the HS and ES groups in terms of operation time [(145.72±50.76) minutes vs. (171.27±66.68) minutes, P=0.005], intra-operative bleeding volume [(71.56±31.34) mL vs. (84.99±36.39) mL, P=0.009], and number of lymph nodes detected (20.92±9.09 vs. 17.90±6.74, P lt;0.05). The postoperative drainage volume and subcutaneous hydrops were not significantly different between the two groups (P gt;0.05). No postoperative hemorrhage occurred in both groups. Conclusion Compared with ES, the use of HS can reduce operation time and intra-operative bleeding volume, and increase the number of lymph nodes detected during modified radical mastectomy.
引用本文： 陳潔,曾荷琳,呂青,田春祥,茍菊香. 超聲刀在乳腺癌Auchincloss改良根治術中. 華西醫(yī)學, 2011, 26(7): 965-967. doi: 復制
| 1. | 吳祥德, 董守義. 乳腺疾病診治[M]. 2版. 北京: 人民衛(wèi)生出版社, 2008: 176-179. |
| 2. | Coutant C, Delpech Y, Morel O, et al. Sentinel node biopsy in invasive breast cancer in 2007[J]. Gynecol Obstet Fertil, 2007, 35(9): 731-742. |
| 3. | 文明星. 乳腺癌外科治療[J]. 臨床外科雜志, 2003, 11(3): 132-133. |
| 4. | Bessa SS, Abdel-Razek AH, Sharaan MA, et al. Laparoscopic cholecystectomy in cirrhotics: a prospective randomized study comparing the conventional diathermy and the harmonic scalpel for gallbladder dissection[J]. J Laparoendosc Adv Surg Tech A, 2011, 21(1): 1-5. |
| 5. | Kakarala K, Faquin WC, Deschler DG. A comparison of histopathologic margin assessment after steel scalpel, monopolar electrosurgery, and ultrasonic scalpel glossectomy in a rat model[J]. Laryngoscope, 2010, 120(4): 155. |
| 6. | 黃盛, 王祎波, 焦亞彬, 等. 超聲刀和電刀對乳腺癌改良根治術后免疫功能及應激的影響[J]. 中國現(xiàn)代普通外科進展, 2011, 13(9): 691-694. |
| 7. | Kozomara D, Gali〖KG-0.7mm〗〖JX-+0.2mm〗〖SX(B-1.6mm〗＇〖〗c〖SX)〗〖JX+0.2mm〗 G, Brekalo Z, et al. A randomised two-way comparison of mastectomy performed using harmonic scalpel or monopolar diathermy [J]. Coll Antropol, 2010, 34(Suppl 1): 105-112. |
| 8. | 肖祥勝, 李峻, 張麗娟, 等. 超聲刀在乳腺癌改良根治術中的應用[J]. 實用醫(yī)學雜志, 2010, 26(23): 4365-4366. |
| 9. | 劉倩, 葉京明, 劉蔭華. 應用超聲刀行乳腺癌腋窩淋巴結(jié)清掃近期療效觀察[J]. 中國實用外科雜志, 2011, 31(4): 228-230.〖ZK)〗. |
| 10. | Manouras A, Markogiannakis H, Genetzakis M, et al. Modified radical mastectomy with axillary dissection using the electrothermal bipolar vessel sealing system[J]. Arch Surg, 2008, 143(6): 575-580. |
| 11. | 黃盛, 王祎波, 焦亞彬, 等. 超聲刀在乳腺癌改良根治術中應用效果研究[J]. 中國現(xiàn)代手術雜志, 2010, 14(5): 337-339. |
| 12. | 劉春萍, 石嵐, 程波, 等. 超聲刀與電刀在乳腺癌手術治療中應用效果比較[J]. 華中醫(yī)學雜志, 2005, 29(6): 455-456. |
| 13. | 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中的應用[J]. 中國普外基礎與臨床雜志, 2010, 17(12): 1245-1248. |
| 14. | 魏濤, 李志輝, 朱精強. 超聲刀與傳統(tǒng)方法在開放甲狀腺手術的臨床對比研究[J]. 中國普外基礎與臨床雜志, 2008, 15(5): 323-326. |
- 1. 吳祥德, 董守義. 乳腺疾病診治[M]. 2版. 北京: 人民衛(wèi)生出版社, 2008: 176-179.
- 2. Coutant C, Delpech Y, Morel O, et al. Sentinel node biopsy in invasive breast cancer in 2007[J]. Gynecol Obstet Fertil, 2007, 35(9): 731-742.
- 3. 文明星. 乳腺癌外科治療[J]. 臨床外科雜志, 2003, 11(3): 132-133.
- 4. Bessa SS, Abdel-Razek AH, Sharaan MA, et al. Laparoscopic cholecystectomy in cirrhotics: a prospective randomized study comparing the conventional diathermy and the harmonic scalpel for gallbladder dissection[J]. J Laparoendosc Adv Surg Tech A, 2011, 21(1): 1-5.
- 5. Kakarala K, Faquin WC, Deschler DG. A comparison of histopathologic margin assessment after steel scalpel, monopolar electrosurgery, and ultrasonic scalpel glossectomy in a rat model[J]. Laryngoscope, 2010, 120(4): 155.
- 6. 黃盛, 王祎波, 焦亞彬, 等. 超聲刀和電刀對乳腺癌改良根治術后免疫功能及應激的影響[J]. 中國現(xiàn)代普通外科進展, 2011, 13(9): 691-694.
- 7. Kozomara D, Gali〖KG-0.7mm〗〖JX-+0.2mm〗〖SX(B-1.6mm〗＇〖〗c〖SX)〗〖JX+0.2mm〗 G, Brekalo Z, et al. A randomised two-way comparison of mastectomy performed using harmonic scalpel or monopolar diathermy [J]. Coll Antropol, 2010, 34(Suppl 1): 105-112.
- 8. 肖祥勝, 李峻, 張麗娟, 等. 超聲刀在乳腺癌改良根治術中的應用[J]. 實用醫(yī)學雜志, 2010, 26(23): 4365-4366.
- 9. 劉倩, 葉京明, 劉蔭華. 應用超聲刀行乳腺癌腋窩淋巴結(jié)清掃近期療效觀察[J]. 中國實用外科雜志, 2011, 31(4): 228-230.〖ZK)〗.
- 10. Manouras A, Markogiannakis H, Genetzakis M, et al. Modified radical mastectomy with axillary dissection using the electrothermal bipolar vessel sealing system[J]. Arch Surg, 2008, 143(6): 575-580.
- 11. 黃盛, 王祎波, 焦亞彬, 等. 超聲刀在乳腺癌改良根治術中應用效果研究[J]. 中國現(xiàn)代手術雜志, 2010, 14(5): 337-339.
- 12. 劉春萍, 石嵐, 程波, 等. 超聲刀與電刀在乳腺癌手術治療中應用效果比較[J]. 華中醫(yī)學雜志, 2005, 29(6): 455-456.
- 13. 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中的應用[J]. 中國普外基礎與臨床雜志, 2010, 17(12): 1245-1248.
- 14. 魏濤, 李志輝, 朱精強. 超聲刀與傳統(tǒng)方法在開放甲狀腺手術的臨床對比研究[J]. 中國普外基礎與臨床雜志, 2008, 15(5): 323-326.