医用胶在腹腔镜完全腹膜外疝修补术中减少术后血清肿的体会

目的探讨医用胶在腹腔镜完全腹膜外疝修补术（total extraperitoneal,TEP）中应用减少术后患者腹股沟区血清肿价值和意义。 方法回顾性分析2016年1月至2017年3月,南京中医药大学附属南京市中西医结合医院行TEP手术的60例患者临床资料,采用随机数字表法分为观察组（使用医用胶30例）和对照组（不使用医用胶30例）。观察比较2组患者术后血清肿发生率。 结果2组患者均手术顺利,均无近期复发。观察组术后血清肿发生率10%（3例）比对照组33.3%（10例）低,差异有统计学意义（P<0.05）。 结论医用胶在TEP中应用,对防止TEP术后发生血清肿的效果优良,减少患者痛苦,值得临床应用。     

腹股沟疝修补术后放置引流与否对血清肿形成的影响的Meta分析

目的分析比较腹股沟疝修补术后放置引流与不放置引流对预防血清肿形成的疗效。 方法检索PubMed、web of science、science direct、ovid和CNKI数据库,检索时限均为从建库至至2016年10月,选择腹股沟疝修补术后放置引流与不放置引流的临床对照研究,2位作者分别独立进行文献筛选、资料提取及质量评估,使用Cochrane 5.0.1系统评价手册进行Meta分析。 结果共纳入2项随机对照临床研究和4项回顾性临床对照研究,包括3 448例患者,其中术后放置引流组2 607例,术后未放置引流组841例。对纳入研究进行整体分析显示,放置引流组总体在减少术后血清中发生率方面高于未放置引流组（P=0.007）,相对危险度为0.29,95%可信区间（CI）：0.12~0.72;放置引流组总体在增加手术时间方面高于未放置组（P=0.006）,标准化均数差为0.36,95% CI：0.22~0.51。2组总体在住院时间比较,差异无统计学意义（P>0.05）。 结论腹股沟疝术后放置引流可以减少术后严重血清肿的形成,因此是安全可行的。     

Prophylactic incisional negative pressure wound therapy shows promising results in prevention of wound complications following inguinal lymph node dissection for Melanoma: A retrospective case-control series

BackgroundInguinal lymphadenectomy (ILND) for melanoma is associated with a number of complications including seroma, surgical site infection (SSI), and lymphedema. Incisional negative pressure wound therapy (iNPWT) has shown promising results in preventing postoperative morbidity across a wide variety of surgical procedures, but these results are yet to be investigated in patients undergoing ILND for melanoma.MethodsIn this study, we reviewed the data of 55 melanoma patients treated with ILND between January 2015 and January 2017 at Odense University Hospital. Patients were followed up until April 2018 for the occurrence of seroma, SSI, and lymphedema. We used prophylactic iNPWT after ILND in 14 patients and compared their morbidity outcomes with the 41 patients receiving standard postoperative wound care in the same period.ResultsThe iNPWT intervention significantly reduced seroma compared to the control group (28.6% vs. 90.3%, p < 0.001) and had a trending impact on wound infection (42.9% vs. 65.9%, p = 0.13). The effect was not significant for the prevention of lymphedema (35.7% vs. 51.2%, p = 0.33). Because the iNPWT group had relatively fewer incidences of seroma, SSI, and lymphedema, the iNPWT intervention was more cost-effective than conventional wound care (US$911.2 vs. US$2542.7, p < 0.05).ConclusionThe use of prophylactic iNPWT significantly reduced seroma formation following ILND. These promising results, however, need to be confirmed in a future prospective randomized trial.     

Complications of sentinel lymph node biopsy for melanoma – A systematic review of the literature

Purpose

The complications reported after sentinel lymph node biopsy (SLNB) for melanoma is highly variable in the worldwide literature; the overall complication rate varies between 1.8% and 29.9%. With heterogeneous reporting of morbidity data, no ‘average’ complication rates of this procedure have been reported. This systematic review aims to determine the complications rates associated with SLNB.

基于4DCT探讨金属夹、血清肿及两者结合勾画靶区对EB-PBI剂量学参数影响

目的 基于4DCT扫描探讨金属夹、血清肿及两者结合勾画靶区对部分乳腺外照射(EB-PBI)的剂量学参数影响。方法 选取2009—2013年间接受保乳手术并符合EB-PBI条件的20例患者入组。在4DCT 10个时相上,分别基于金属夹、血清肿及两者结合勾画GTV_C、GTV_S、GTV_C+S,并将10个时相图像上GTV分别融合得到IGTV_C、IGTV_S、IGTV_C+S,边界外扩15 mm作为PTV_C、PTV_S、PTV_C+S。由同一物理师在吸气末时相图像上分别基于PTV_C、PTV_S、PTV_C+S制定3DCRT计划,比较3组间靶体积、HI、CI及OAR剂量体积差异。结果 3个组间 IGTV、PTV及PTV与患乳体积比差异均有统计学意义(P均<0.05),血清肿组<金属夹组<金属夹结合血清肿组,血清肿组患侧正常乳腺、患侧肺受量小于金属夹组及金属夹结合血清肿组(P均<0.05),3个组间HI、CI差异均无统计学意义(P均>0.05)。结论 在4DCT图像上基于不同参照物构建靶区导致的体积差异对靶区剂量分布无明显影响,但对患侧乳腺及患侧肺受量却有明显影响。     

金葡素治疗吸脂术后血清肿机制的初步探讨

目的 探讨金葡素治疗吸脂术后血清肿的可能机制.方法 对64例吸脂术后血清肿患者分别应用常规和金葡素治疗,然后每日采集渗出液,并对渗出液的比重、pH值、细胞类别及数量,以及总蛋白(TP)、碱性磷酸酶(ALP)、乳酸脱氢酶(LDH)、天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、γ-谷氨酰基转移酶(γ-GT)、腺苷脱氨酶(ADA)、载脂蛋白B(ApoB)、总胆固醇(TC)等生化指标进行分析.结果 金葡素治疗组患者治疗7 d后渗出液比重增高,淋巴细胞、间皮细胞的数量增加,TP、LDH、ADA、TC等多种生化指标均有明显升高,其中渗出液比重1.086±0.002、TP(42.1±0.32)g/L、LDH(343.2±9.1)U/L、ADA(19.2±5.14)U/L、TC(0.42±0.02)mmol/L.有核细胞计数平均为600×106/L,其中淋巴细胞占78%,间皮细胞占10%,与常规治疗组比较差异有统计学意义(P<0.05,P<0.01).结论 金葡素治疗组渗出液比重、细胞类别、数量以及多种生化指标的变化是金葡素刺激浆膜以及周围组织产生炎性反应引起的,无菌性炎性反应可能是金葡素治疗吸脂术后血清肿的机制.     

Lanreotide autogel 90 mg and lymphorrhea prevention after axillary node dissection in breast cancer: A phase III double blind,randomized, placebo-controlled trial

Aim

The aim of this study was to assess the efficacy of Lanreotide Autogel 90 mg PR to prevent lymphorrhea after axillary dissection in breast cancer.

Methods

A Phase III double-blind, randomized, placebo-controlled trial was performed between April 1st, 2008, and December 31st, 2010. The primary endpoint was the lymphorrhea volume (ml) in the axillary drain during the first four postoperative days. The secondary end points were the number of days until axillary drain removal, hospital stay duration (days), lymphorrhea volume (ml) up to days 15, 30 and 180, number of cases with seroma aspiration and number of seroma aspirations, evaluation of wound, arm pain and mobility on days 15, 30 and 180.

Results

A total of 148 patients were recruited for the study. Altogether 145 patients were randomized and analysed on an intention-to-treat basis. On the day before surgery 73 patients received the placebo and 72 patients received lanreotide. At four postoperative days, there was a tendency towards a reduction of the lymphorrhea volume in the lanreotide group (median 292 ml, range 1–965 ml) as compared to the placebo group (median 337 ml, range 0–1230 ml), although it was not statistically significant (p = 0.18). There was no significant difference for the secondary end points. In the group with axillary dissection performed alone (n = 24), the lymphorrhea volume was shown to be significantly reduced in the lanreotide group, (p = 0.035) as compared to the placebo group.

Conclusion

Our study did not identify any overall significant reduction of lymphorrhea on lanreotide.     

乳腺癌改良根治术后皮下积液的发生原因与防治

目的探讨乳腺癌改良根治术后皮下积液产生的原因及防治方法。方法 80例乳腺癌改良根治术患者经积极治疗基础疾病,注意手术技巧及合理的引流、护理,以预防皮下积液发生。结果 80例乳腺癌患者中13例发生皮下积液(16.3%),9例经反复穿刺抽液,2例经调整引流管位置,2例经重新置管、负压引流,加压包扎等治疗,2周内治愈。结论采取综合预防和治疗措施明显降低了皮下积液的发生率,提高了患者的生活质量。     

Planning the breast boost: How accurately do surgical clips represent the CT seroma?

Background and purpose

To measure the distance between surgical clips and edge of CT-defined seroma in a coronal plane in women who have undergone wide local excision of breast cancer and to evaluate dosimetric coverage of CT-defined boost volumes by conventional clip-based electron fields.

Materials and methods

Planning CT images of 30 lumpectomy cavities from 30 patients were reviewed. All seroma cavities had at least 4 clips and Cavity Visualization Score ?3. Distances between clips and seroma edge (D_c-s) were measured at the radial margins for each patient. Clips-based electron fields were generated by including all the clips with 2 cm margin in the coronal plane and three-dimensional conformal radiotherapy plans (3D-CRT) were devised based on CT tumor beds (CT-TBs). The parameters of dose-volume histogram between the two boost treatment plans were analyzed.

Results

The mean seroma edge extended beyond the clips by 0.3-0.5 cm. In all 120 D_c-ss, 76.7% were ?0.5 cm, 8.3% were >1 cm and 15% were between 0.5 and 1 cm. Twenty patients (20/30) had D_c-smax (The maximal D_c-s of each patient) > 0.5 cm and 7 patients had D_c-smax > 1 cm. With the electron fields, only 46.7% (14/30) had D₉₀ (The minimal dose received by 90% of the planning target volume (PTV)) > 90% and geographical miss (any portion of the PTV receiving <50% of the prescribed dose) was found in 36.7% (11/30). D_c-smax > 0.5 cm was associated with D₉₀ < 90% (P < 0.001) and >1 cm was associated with geographic miss (P = 0.001).

Conclusions

Surgical clips are not always consistent with the edge of seroma. Electron boost field based on clips leads to insufficient dose coverage to the CT-TB. 3D-CRT planning should be considered to ameliorate the dose coverage to the tumor bed.