改良乳腺癌根治术后皮瓣坏死的预防

目的 探讨如何降低改良乳腺癌根治术后皮瓣坏死的发生率。方法 902例采用改良乳癌根治术患者被分为2组。1987至1995年的434例是作为对照组,而1996至2004年是作为研究组。对两组间术后皮瓣坏死情况进行对比研究。结果 对照组术后皮瓣坏死率是23．7％,而研究组是4．5％,两组之间有显著差异（P〈0．05）。结论 预防改良乳癌根治术后皮瓣坏死的关键是合理的皮瓣厚度,避免皮瓣张力,防止淋巴管漏,有效双管引流,合适包扎。     

乳癌改良根治术后皮瓣坏死的分析及护理

目的探讨乳腺癌改良根治术后皮瓣坏死的原因及护理体会。方法将2003-01—2011-01间采用预防皮瓣坏死的新方法的115例乳癌改良根治术患者作为观察组,以1997-01—2002-02未采用新方法 42例行改良根治术患者作为对照组。比较2组术后皮瓣坏死率。探讨皮瓣坏死的原因及护理体会。结果对照组皮瓣坏死率18.9%,观察组皮瓣坏死率2.7%,两组比较差异有统计学意义(P<0.01)。结论合理的皮瓣厚度,避免皮瓣缝合张力,保持通畅引流等综合治疗及护理措施,可降低乳癌改良根治术后皮瓣坏死率。     

生肌橡皮膏治疗乳腺癌根治术后皮瓣坏死

我院自1989年以来共施行乳腺癌根治术257例,术后发生皮瓣坏死97例.1989-1995年间应用雷佛奴尔纱条换药,1995年后改用生肌橡皮膏,现总结如下.     

乳腺癌根治术后皮瓣坏死原因分析

皮瓣坏死是乳腺癌根治术后最常见的并发症之一，国外报道发生率为10％-60％，国内报道为51％-71％。其延长了患者的住院时间，给患者带来了身体、精神和经济上的负担，并使术后放、化疗的时间推后，延误了病人的治疗。本文对1999年9月至2006年9月期间的120例用不同手术方法行乳腺癌根治术的病人进行分析比较，旨在研究不同手术方法对术后皮瓣愈合的影响。     

乳腺癌根治术的皮瓣处理

1989年1月至1991年12月,我们共施行乳腺癌根治术54例,其皮瓣处理方法随机分成皮瓣戳孔加压包扎组和皮下置管负压吸引组,结果前者术后皮下积血、积液和皮肤坏死等并发症的发生率明显低于后者,有显著性差异(P相似文献   

乳腺癌根治术后预防皮瓣坏死的探讨

目的认识和探讨乳腺癌根治术后皮瓣坏死的前体症及发生率。方法通过对58例手术病历采用预防皮瓣坏死新方法的乳腺癌根治术与过去的480例乳腺癌根治术病例分组对比进行探讨。结果乳腺癌根治术的皮瓣坏死率由原来的32%降低到目前的2%,根据统计,二者明显差异。结论在乳腺癌根治术中关键在于防止腋下积液(淋巴管瘘),皮瓣游离区及腋下引流、术后胸带的松紧度及游离皮瓣的厚度和切缘缝合的张力。     

乳腺癌改良根治术皮瓣处理效果分析

目的探讨乳腺癌改良根治术不同皮瓣处理方法对术后皮下积液及切口皮缘坏死的影响。方法回顾分析4年余行乳癌改良根治术（保留胸大、小肌）119例的临床资料，分析术中4种皮瓣处理方式的术后皮下积液及切口皮缘坏死的情况。结果119例患者术后发生皮下积液和／或皮缘坏死共43例。用横切口的79例中，术后积液13例，皮缘坏死3例；用纵切口40例中积液20例，皮缘坏死7例；用“皮瓣处理1”60例中积液23例，皮缘坏死8例；用“皮瓣处理2”59例中积液10例，皮缘坏死2例。结论横切口加1／400肾上腺素生理盐水皮下注入，加刀片分离皮瓣、加“铆钉”式缝合固定皮瓣的术式能有效地减少术后皮下积液和切口皮缘坏死的发生率。     

康复新液治疗乳腺癌根治术后皮瓣坏死创面不愈的效果

目的 探究康复新液治疗乳腺癌根治术后皮瓣坏死创面不愈的效果。方法 选取2021年10月-2022年 10月于本院实施乳腺癌根治术且术后存在皮瓣坏死创面不愈的80例患者为研究对象,采用随机数字表 法分为观察组和对照组,每组40例。对照组给予碘伏换药治疗,观察组给予康复新液治疗,比较两组 临床疗效及临床指标。结果 观察组治疗总有效率为95.00%,高于对照组的85.00%,差异有统计学意义 （P＜0.05）;观察组新生上皮出现时间、创面愈合时间、上肢康复活动时间均短于对照组,创面面积小于 对照组,VAS评分低于对照组,差异有统计学意义（P＜0.05）。结论 康复新液治疗乳腺癌根治术后皮瓣 坏死创面不愈的效果良好,能够有效抑制创面处的炎症反应,减轻患者疼痛感,有利于提高愈合速度,缩 小创面面积,提升愈合效果。     

乳腺癌改良根治术皮瓣厚度选择临床研究

目的 探讨乳腺癌改良根治术中皮瓣厚度的选择,降低术后并发症发生率。方法 对2008年1~12月河南省人民医院乳腺外科78例行乳腺癌改良根治术的临床资料进行回顾性分析。将2008年1~6月的病人设为Haagensen皮瓣组,2008年7~12月的病人设为胸壁浅筋膜外组,对两组病人术中出血量、手术时间及术后并发症发生率进行对比研究。结果 胸壁浅筋膜外组的手术中出血量、手术时间、手术后总引流量及术后皮瓣坏死发生率均低于Haagensen皮瓣组,差异有统计学意义（P＜0.05）;手术后皮下积液发生率两组相比差异无统计学意义（P＝0.522）。结论 选择在紧贴胸壁浅筋膜浅层外侧的脂肪层中游离皮瓣,可有效降低乳腺癌根治术后并发症发生率。     

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目的 探讨如何降低乳腺癌根治术后皮瓣坏死的发生率。方法 对45例采用预防皮瓣坏死新方法的乳腺癌根治术病例与过去实施的1210例乳腺癌根治术病例进行了分组对比研究。结果 乳腺癌根治术后的皮瓣坏死率由原来的45%下降到目前的2%,经统计学处理,二者有极显著差异。结论 预防乳腺癌根治术后皮瓣坏死的关键是：防止腋下淋巴管瘘,腋下肋下置双管引流,合适的胸带包扎力,合理的皮瓣厚度及皮瓣缝合不能有张力。     

乳腺癌根治术后创面不加压包扎对预防皮瓣坏死的影响

目的探讨乳腺癌术后皮瓣坏死的发生原因及预防措施。方法回顾性分析2006年1月～2010年12月郑州人民医院280例乳腺癌手术患者的临床资料,其中创面加压包扎140例,创面不加压包扎140例。结果乳腺癌根治术后创面加压包扎皮瓣坏死29例,发生率为20.71%,创面不加压包扎皮瓣坏死15例,发生率为10.71%。结论乳腺癌根治术后创面不加压包扎是预防皮瓣坏死的一种方法。     

微创缝合局部加压包扎预防乳癌术后皮瓣坏死

目的 报告一种微创缝合皮瓣、胸壁局部加压包扎预防乳腺癌根治术后皮瓣坏死的方法。方法 乳腺癌根治术或改良根治术缝合皮瓣时,用细皮针1号线小边距缝合皮缘,两侧皮瓣基底部外侧的胸壁间断缝线,局部“打包”加压包扎。结果 本组268例均无明显皮瓣坏死。有13例因淋巴漏缝合处3～5cm裂开,经换药40d内愈合。结论 微创缝合皮缘及皮瓣局部“打包”加压包扎是一种较好的预防乳癌术后皮瓣坏死的方法。     

三种方法修复乳腺癌术后皮瓣坏死

目的:探讨乳腺癌术后皮瓣坏死的治疗方法。方法:采用游离皮片移植、临近皮瓣转移修复和皮肤软组织扩张术修复17例皮瓣坏死的患者。结果:17例皮瓣坏死的病例中,采用游离皮片移植8例,运用背阔肌皮瓣修复2例,临近皮瓣转移修复4例,皮肤软组织扩张器修复3例,除1例全厚皮片移植出现小水疱,1例皮瓣转移修复远端皮瓣部分坏死,经换药等治疗后Ⅱ期愈合外,其余15例均效果良好。结论:乳腺癌术后皮瓣坏死病例,采用游离皮片移植、临近皮瓣转移、皮肤软组织扩张术修复,效果良好。     

Association between skin flap necrosis and sarcopenia in patients who underwent total mastectomy

BackgroundSarcopenia is associated with postoperative complications in patients undergoing digestive surgery. In this study, we investigated the impact of preoperative sarcopenia on postoperative complications in breast cancer patients who underwent total mastectomy.MethodsPatients with breast cancer who underwent total mastectomy were included in the analysis. The relationship between the presence of sarcopenia and postoperative complications (e.g., skin flap necrosis and seroma) and between the incidence of these complications as well as preoperative and surgical factors was investigated. Moreover, the effects of sarcopenia on recurrence-free survival and overall survival were evaluated. The psoas muscle index calculated using values measured on preoperative computed tomography images was used to diagnose sarcopenia.ResultsIn total, 43 (49%) of 88 patients presented with sarcopenia. The number of patients with a Geriatric Nutritional Risk Index score <91 was higher in the sarcopenia group than in the non-sarcopenia group (p = 0.011). Seroma was observed in 32 (36.4%) patients, and no significant difference was observed between the patients with and without sarcopenia (16 [35.6%] in the non-sarcopenia group vs 16 [37.2%] in the sarcopenia group). By contrast, skin flap necrosis was observed in 20 (22.7%) patients, and the number of patients with this complication was higher in the sarcopenia group than in the non-sarcopenia group (15 [34.9%] vs 5 [11.1%]).ConclusionSarcopenia is a risk factor for skin flap necrosis and may be an important factor for preoperative evaluation in patients who will undergo total mastectomy.     

Risk factors of mastectomy skin flap necrosis in immediate breast reconstruction using low abdominal flaps

Background: The purpose of this study was to determine the risk factors associated with mastectomy skin flap necrosis during immediate reconstruction with TRAM or DIEP flaps.

Methods: This study reviewed 1116 cases of immediate breast reconstruction over 10 years. Patients ranged in age from 29–76 years (average = 45.1 years), and had an average follow-up period of 65.6 months. Thirteen factors (age, BMI (body mass index), smoking habits, diabetes ptosis grade, midclavicle-to-nipple distance, neoadjuvant chemotherapy, free or pedicled flap, mastectomy method, surgeon, stage, axillary dissection, mastectomy weight) known to be associated with mastectomy flap necrosis were retrospectively analysed. The odds ratios of the risk factors were calculated using logistic regression analyses.

Results: Mastectomy skin flap necrosis occurred in 247 cases (22.1%). Univariate regression analysis showed that the odds ratio of age, BMI, ptosis grade, midclavicle-to-nipple distance, free flap, mastectomy method, surgeon, stage, and mastectomy weight were significant and the odds ratios determined using multivariate analysis were significant for mastectomy method, surgeon, and mastectomy weight.

Conclusion: During breast reconstruction using abdominal tissue, the independent risk factors that affect mastectomy skin flap necrosis include the mastectomy method, surgeon, and the weight of the mastectomy specimen. Awareness of the impact of each risk factor will lead to the modification and individualisation of surgical techniques and continually improve outcomes.     

乳腺癌保留皮肤改良根治并即刻假体再造与传统改良根治术的疗效比较

目的 比较乳腺癌保留皮肤改良根治并即刻假体再造和传统改良根治术的治疗效果.方法 对2004年1月至2008年12月手术治疗的530例0～Ⅲa期女性乳腺癌患者病例资料进行回顾性分析.530例中,91例行乳腺癌保留皮肤改良根治并即刻假体再造,439例行传统改良根治术.通过比较两组患者术后并发症、局部复发率、远处转移率、病死率的差异,评价乳腺癌保留皮肤改良根治并即刻假体重建与传统改良根治术的疗效.结果 即刻假体再造组随访患者84例,中位随访时间35个月,局部复发率2.4%,远处转移率8.3%,病死率6.0%;改良根治组随访患者439例,中位随访时间36个月,局部复发率3.3%,远处转移率9.5%,病死率6.5%.随访期间两组复发率、转移率、病死率的差异均无统计学意义(P＞0.05).即刻假体再造组术后美观效果随访12个月,医生和患者评估的良好率分别为93%、87%.结论 乳腺癌保留皮肤改良根治并即刻假体再造可以达到和传统改良根治术相当的疗效,并可显著改善患者术后乳房外形美观及生活质量.

Abstract：

Objective To compare the therapy efficiency of immediate implanting breast reconstruction after skin sparing mastectomy and modified radical mastectomy in breast cancer. Methods The data of 530 female patients with early of stage 0 to Ⅲ a breast cancer was retrospectively analyzed, from January 2004 to Decembet 2008. Among the patients,91 patients operated with skin sparing mastectomy and immediate implanting breast reconstruction ( Group of immediate implanting reconstruction), and 439 patients were with modified radical mastectomy (Group of modified radical mastectomy ). By comparing complications, local recurrence, distant metastases and mortality rates between the two groups, the research was done to evaluate the therapy efficiency. Results In the group of immediate implanting reconstruction,84 patients completed follow-up with the median follow-up time of 35 months ( 14-72 months) while the local recurring rate was 2. 4%, distant metastasis rate was 8. 3% and mortality rate was 6. 0%. In the group of modified radical mastectomy, 398 patients completed follow-up with the median follow-up time of 36 months ( 12-74 months) while the local recurring rate was 3.3%, distant metastasis rate was 9. 5% and mortality rate was 6. 5%. Therefore there was no obvious statistic difference between the two groups in local recurring rate, distant metastasis rate and mortality rate (P ＞ 0. 05 ). Evaluation of aesthetic results was done in the 84 patients after immediate implanting reconstruction for 12 months which was 93% as good or excellent by surgeons while 87% by patients. Surgeons and patients were both satisfied with the breast appearance. Conclusions For patients with early stage breast cancer, combining standard postoperative therapy, skin sparing mastectomy and immediate implanting reconstruction could achieve the same effect as the traditional modified radical mastectomy, while reconstruction would bring about better appearance and higher quality of life.     

乳腺癌术中淋巴管显影结扎减少皮下积液的应用

目的:探讨乳腺癌手术时上肢淋巴管显影结扎对减少皮下积液形成的临床意义。方法:选择2009年8月至2011年8月入住我院的172例乳腺癌改良根治术病人。分为研究组和对照组,每组各86例。研究组病人在手术时用0.25%亚甲蓝行上肢淋巴管显影,同时行显影淋巴管结扎;对照组病人常规手术不行淋巴管显影。统计分析两组病人的拔管时间和拔管后积液发生率。结果:两组病人一般情况无统计学差异,研究组平均拔管时间为术后(8.6±10.3)d;对照组为术后(11.5±12.3)d,两者比较有统计学差异﹙P0.001)。研究组拔管后发生积液5例,发生率为5.8%;对照组13例,发生率为15.1%,有统计学差异(P0.05)。结论:乳腺癌改良根治术行腋窝淋巴结清扫时,对上肢来源的淋巴管进行显影,并将断端予以结扎,可缩短拔管时间,减少皮下积液的发生率。     

大鼠皮瓣缺血再灌注损伤的电子顺磁共振观察

为了研究大鼠皮瓣在缺血再灌注时氧自由基的变化，我们应用电子顺磁共振（ＥＰＲ）技术，对缺血再灌注后的ＳＤ大鼠腹壁岛状皮瓣进行了直接检测。结果表明大鼠腹壁皮瓣在缺血再灌注以后产生大量的超氧阴离子自由基（Ｏ－·２）；Ｏ－·２变化十分活跃；大鼠腹壁皮瓣是ＥＰＲ研究氧自由基的较理想的模型。