乳癌术后新型医用胸带的制作与应用

目的 探讨预防和减少乳癌术后皮下积液、皮瓣坏死等并发症的有效措施.方法 将80例乳癌术后患者随机分为观察组(42例)和对照组(38例).对照组使用传统的绷带包扎方法,观察组采用自制乳癌术后新型医用胸带.采用问卷法询问患者舒适度,观察术后皮下积液、皮瓣坏死等并发症发生率,换药时间及次数、引流管引流时间等.结果 两组舒适度、皮下积液发生率比较,差异有显著性意义(均P＜0.01);两组换药时间及次数、引流时间比较,差异有显著性意义(P＜0.05,P＜0.01).结论 乳癌术后新型医用胸带使用安全、舒适,可减少并发症发生,促进乳癌患者术后早日康复.     

乳腺癌根治术后单纯负压引流与负压引流联合胸带加压包扎的效果比较

目的比较单纯负压引流与负压引流联合胸带加压包扎两种方法在预防乳腺癌术后皮下积液、皮瓣坏死以及患者舒适度方面的差异。方法收集2010年1月至2012年12月期间我院收治的196例乳腺癌根治手术病例,术后采用腋窝及胸壁放置双管负压引流并加用多头胸带加压包扎（简称“负压引流联合胸带加压组”,n=112）和仅腋窝及胸壁单纯放置双管负压引流（简称“单纯负压引流组”,n=84）2种不同方式预防术后皮下积液发生,通过对比其术后并发症、术后3d引流量、患者舒适度等相关因素,综合评估两种方法的效果。结果本组196例乳腺癌根治手术患者均为女性。2组患者的一般临床资料比较差异均无统计学意义（P〉0．05）,具有可比性。单纯负压引流组和负压引流联合胸带加压组的胸壁拔管中位时间（7．00d比7．00d,P=O．053）、腋窝拔管中位时间（15．00d比16．00d,P=-O．080）、术后3d中位引流量（368mL比365mL,P=O．080）及皮下积液发生率（19．1％（16／84）比17．8％（20／112）,P=O．922]和皮瓣坏死发生率[2．4％（2／84）比5．4％（6／112）,P-O．498]比较差异均无统计学意义,但单纯负压引流组患者术后舒适度满意率明显高于负压引流联合胸带加压组[76．2％（16／84）比22．3％（25／112）,P〈0．001]。2组患者均未影响术后放化疗。结论与负压引流联合胸带加压包扎相比,单纯负压引流在没有增加乳腺癌根治术后皮下积液、皮瓣坏死等并发症发生率的情况下,大大提高了患者术后舒适满意度。     

乳腺癌术后皮下积液引流方法探讨

目的探讨乳腺癌术后皮下积液的最佳引流方法。方法将79例乳腺癌术后皮下积液患者随机分为三组：负压引流组30例,将皮下积液排出后继续保留负压引流管引流;半管引流组22例,采用橡胶管半管引流条1根在积液腔最低处置入引流;硅胶管引流组27例,采用一次性硅胶导尿管,将置入体内的导管再剪2～3个侧孔,在积液腔最低处置入引流。观察三组愈合时间和皮瓣坏死率。结果硅胶管引流组平均愈合时间和皮瓣坏死率显著优于负压引流组和半管引流组（P〈0.01,P〈0.0125）,负压引流组和半管引流组比较,差异无显著性意义（P〉0.05,P〉0.0125）。结论硅胶管引流比较彻底,可缩短伤口愈合时间,降低皮瓣坏死率。     

负压引流器在乳癌手术中的应用体会

负压引流器在乳癌手术中的应用体会山东省枣庄矿务局中心医院普外科（２７７０１１）张钦增于建利１）唐鲁兵韩青阳乳癌根治术后皮下积液与皮瓣坏死是其主要并发症。我科自１９９１年开始在乳癌术后应用一次性负压引流器（以下称负压引流器），既减少了皮下积液的发生率，...     

造口袋在胃肠道手术后腹腔引流中的应用

目的观察造口袋在胃肠道手术后腹腔引流中的应用效果。方法将32例胃肠道手术后,腹腔引流管管周渗液或拔管后窦道渗液的患者随机分为对照组与观察组各16例。对照组使用传统方法换药,观察组采用造口袋引流接纳渗液。比较两组窦道愈合时间、换药次数及患者舒适度。结果观察组窦道愈合时间、换药次数及患者舒适度显著优于对照组（P〈0．01,P〈0．05）。结论造口袋辅助应用于胃肠道手术后的腹腔引流可促进窦道愈合,减少护理工作量,提高患者舒适度。     

经套管针负压持续引流治疗乳癌术后迟发皮下积液

目的介绍一种经套管针负压持续引流治疗乳癌术后迟发皮下积液的方法。方法确定乳癌术后迟发皮下积液者,取长6cm的18G静脉留置套管针插入积液腔,抽尽液体后接延长管和负压球进行持续负压吸引,并与单次抽吸法作对照。结果经套管针负压持续引流组和单次抽吸组的引流时间、换药次数和费用分别为3．812±0．92Vs4．933±0．96（天）、1．25±0．45Vs3．13±0．83（次）和24．90±10．68Vs83．60±12．27（元）。结论套管针经皮穿刺置管持续负压引流治疗乳癌术后迟发皮下积液效果好,且费用低。     

益气活血通络中药在乳癌术后早期的运用

目的：探讨益气活血中药对乳腺癌术后早期恢复的影响。方法：将54例患者随机分成两组,中药治疗组26例术后第1d开始益气活血中药治疗,对照组28例常规治疗。对比观察术后胸骨旁引流管、腋下引流管的拔管时间及皮下积液和皮瓣坏死的发生率。结果：治疗组术后胸骨旁引流管、腋下引流管的拔管时间较对照组明显缩短（P〈0.01～0.05）,皮下积液及皮瓣坏死的发生率明显降低（P〈0.05）。结论：乳癌术后早期运用益气活血通络中药,可减少皮下积液及皮瓣坏死的发生率,缩短胸骨旁引流管及腋下引流管的拔管时间,有利于患者早期恢复。     

乳腺癌改良根治术后皮下积液的预防措施

目的 探讨乳腺癌术后皮下积液的防治方法。方法 回顾北京友谊医院普外科2002年1月～2004年12月收治的女性乳腺癌患者312例。比较皮下引流管接持续高负压吸引组（A组）与持续低负压引流组（B组）,乳腺癌改良根治术后皮下积液的发生率。结果 A组160例患者拔管前合计引流量220～350ml,平均270ml。35例发生皮下积液,积液发生率为21．8％。同时伴皮瓣坏死5例。B组152例患者拔管前合计引流量160～250ml,平均180ml。17例发生皮下积液,积液发生率为11．2％。皮瓣坏死3例。B组与A组比较皮下积液发生率有显著性差异（P=0．011）。结论 乳腺癌改良根治术后引流管接持续低负压吸引有助于减少皮下积液的发生率。     

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。     

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。     

Breast

<正>210378 Expression and significance of stromal CD10 and Ezrin inductal carcinoma in situ and invasive ductal carcinoma of breast/Zhang Rongju(张荣菊,Breast Cancer Research Key Lab Educat Minis Nation,Oncol Key Lab Tianjin,Tianjin Cancer Inst Cancer Hosp,Tianjin Med Univ,Tianjin 300060)…Chin J Exp Surg.-2010,27(6).-705～707     

Breast

<正>209026 Relationship between breast cancer-related lymphoedema and VEGF-C and VGGFR-3/He Jianye (贺建业,DeptGen Surg,Anzhen Hosp,Cap Univ Med Sci, Beijing 100029)…∥Chin J Gen Surg. -2009,24(11). -900～903 Objective To study the distributionand clinicopath-ological characteristics between VEGF-C and peritumoral lymph vessels density (PlND) in breast cancer tissue,and to investigate the development and the mechanism of breast cancer-related lymphoedema(BCRL).     

Case Report: Breast Seroma Mimicking Breast Implants

Introduction Breast seroma may be caused by a variety of factors including lymphatic disruption, continuous inflammation and foreign bodies such as breast implants. In cases of breast implants associated seroma the diagnosis of Anaplastic Large Cell Lymphoma (ALCL) should be investigated.Presentation of Case A 45-year-old Caucasian woman was referred with bilateral swelling of the breasts causing tension and pain. MRI showed accumulations compatible with bilateral silicone implants. Ultrasound-guided aspiration showed no malignancy or silicone. The patient had a history of both soy- and silicone implants. Three years prior her breast implants was removed due to capsule formation. To treat the pain and rule out potential malignancy we performed capsulectomy of only the right breast, on the wish of the patient. We found brown fluid, no breast implants and histology of fluid and tissue showed no malignancy.DiscussionBreast seroma usually develops weeks after surgery such as mastectomy or axillary lymph node dissection. This patient developed a seroma through months and years after her last surgery. In cases of late seroma malignancy should be ruled out. Diagnostic statements should not solely be based on radiology, but in conjunction with clinical findings.ConclusionWe performed capsulectomy on a patient with breast seroma mimicking breast implants. We excluded the diagnosis of breast implant-associated ALCL. Radiology has limitations and should be considered in conjunction with the patient’s statement and the clinical findings.     

Etiology of Breast Masses after Autologous Breast Reconstruction

Background

Determining the nature of a breast mass after autologous reconstruction can be difficult.

Methods

A retrospective review of all autologous breast reconstructions was performed over 10 years. All postoperative breast masses were identified. Tumor characteristics, adjuvant treatment, timing of the development of the mass, and correlation with radiology were reviewed.

Results

A total of 365 flaps were performed on 272 patients [253 deep inferior epigastric perforator (DIEP), 35 superficial inferior epigastric artery (SIEA), 22 muscle-sparing free transverse rectus abdominis myocutaneous (free MS-TRAM), 25 latissimus, and 30 pedicled TRAM]. Breast masses were identified in 66 breasts (18 %). The majority of these were from fat necrosis, occurring in 54 breasts (15 % overall; DIEP 13.4 %, SIEA 5.7 %, free MS-TRAM 15 %, latissimus 0 %, pedicled TRAM 47 %), first identified at a mean of 3 months. Recurrent carcinoma was diagnosed in 13 breasts (3.6 %). Factors associated with the postreconstruction mass representing recurrent carcinoma were later time period after reconstruction (mean 24 months), closer surgical margins, and lymphovascular invasion. Radiographic imaging accurately diagnosed recurrent carcinoma in 11 (92 %) of 12 patients in whom it was utilized and suggested a benign diagnosis in all 16 patients with fat necrosis in whom it was utilized.

Conclusions

Breast masses frequently present after autologous reconstruction. Fat necrosis is the most common cause. Recurrent carcinoma can occur in the reconstructed breast and presents later. A higher index of suspicion for recurrence should accompany any mass in which prior lymphovascular invasion was present or if original margins were <1 cm. Radiographic imaging accurately identifies the cause of these masses.