【作者】 沈俊；

【导师】 王林波；

【作者基本信息】 浙江大学 ， 临床医学， 2009， 硕士

【摘要】 目的:探讨乳腺癌术后引流液及皮下积液的来源,发生皮下积液的高危因素;寻找缩短引流时间、减少积液发生率的有效途径。方法:本研究采用回顾性研究联合随机前瞻性研究的方法,回顾2003年3月至2006年6月的病历资料(对照组,n=84),将2006年6月至2009年2月的病例(n=111)随机分为3组,分别为丝线结扎腋窝上肢来源淋巴管组(结扎组,n=91)、超声刀腋窝清扫组(超声刀组,n=7)、丝线结扎腋窝上肢来源淋巴管但新式引流球负压引流组(新球组,n=13),比较各组病例之间年龄、肿瘤大小、腋窝淋巴结转移情况、腋窝处理、手术方式、术后放化疗情况等危险因素,比较各组间术后引流时间、引流量、皮下积液等并发症发生率等情况,并分析危险因素与引流时间、皮下积液发生率之间的关系;用上肢淋巴闪烁造影证实积液为淋巴漏来源。结果:造影剂于腋窝积液处异常浓聚,这一现象证实了淋巴漏是皮下积液的来源之一;所有195例病例资料的平均引流时间为16±15天,皮下积液发生率为4.1%;结扎腋窝上肢来源淋巴管组较对照组拔管时间显著缩短(14.22±12.17天VS19.48±18.41天,p＜0.05),且积液发生率明显降低(1/91 VS 7/84,p＜0.05);改良根治组较保乳根治组术后72小时引流液显著为多(257.33±134.63ml VS190.95±110.62ml,p＜0.05),拔管时间无明显缩短(16.07±14.19天VS 17.02±18.04天,p＞0.05),积液发生率无明显增多(4/139 VS 4/56,p＞0.05);术后化疗组拔管时间较术后无化疗组显著延长(17.35±16.12天VS 10.11±6.49天,p＜0.05),积液发生率无明显差异(0/17 VS 8/168,p＞0.05)。结论:淋巴漏是乳腺癌术后引流液和皮下积液的主要来源,术后早期(3天)引流液以渗出液为主;结扎腋窝淋巴管能有效缩短引流时间,降低皮下积液发生率;化疗是引流时间延长、积液发生率升高的危险因素之一。更多还原

【Abstract】 Object:To investigate the source of the drainage and the seroma following surgery for breast cancer and the high-risk factors for seroma;to find a effective way to shorten the time for drainage and decrease the incidence of seroma.Method:Retrospective study and random perspective study are both used in this study.We reviewed the data from 3/2003 to 6/2006(control group,n=84).The patients in 6/2006 to 2/2009(n=111) were taken into three groups randomly,the axillary lymphatic from upper extremity of ligature group patients were ligated by ligature(n=91);the axillary lymph node dissection in the patients of ultracision group were done by ultracision(n=7); the patients in new J-P group were suction drained by the new J-P suction drainage system(n=13).Analyze the correlation between the risk factors and the time for drainage, the volume of drainage,seroma and other complications.We confirmed that seroma ascribes the lymphorrhea by lymphoscintigraphy.Result:Tc-99 was concentration in the axilla where the drainage accumulative,it means that lymphorrhea is one of the reason for seroma;the average days for drainage is 16±15 day,and the incidence of seroma is 4.1%.The time for drainage in the group whose lymphatic in the axilla were ligatured is distinguished shorter than which in the control group(14.22±12.17days VS 19.48±18.41days,p＜0.05);and the incidence of seroma is the same(1/91 VS 7/84,p＜0.05);the volume of draining for 72h after modified radical operation is extraordinarily more than which after conservative breast surgery(257.33±134.63ml VS 190.95±110.62ml,p＜0.05),and the time for drainage (16.07±14.19days VS 17.02±18.04days,p＞0.05) and the incidence of seroma(4/139 VS 4/56,p＞0.05) are no difference;the time for drainage of the patients who did adjuvant chemotherapy is distinguished longer than the time for the patients who didn’t do adjuvant chemotherapy(17.35±16.12days VS 10.11±6.49days,p＜0.05),the incidence of the seroma is no difference(0/17 VS 8/168,p＞0.05).Conclusion:Lymphorrhea is the lnean source of the drain fluid and the seroma following surgery for breast cancer,although extravasate is the mean composition in the first 72h after the surgery;ligatured the lymphatic in the axilla can shorten the time for drainage and decrease the incidence of seroma effectually,chemotherapy is one of the risk factor for needing more drainage and an increased incidence of seroma.更多还原