超声刀在乳腺癌改良根治术中的临床应用

目的 研究超声刀在乳腺癌手术中的应用价值.方法 回顾性分析上海市杨浦区中心医院2010年1月～2013年3月收治的乳腺癌改良根治术患者210例,其中110例联合使用超声刀与电刀（超声刀组）,100例单用电刀（电刀组）.比较两组手术总时间、全乳腺切除时间、腋窝淋巴结清扫时间,术后24h引流情况、引流管放置时间以及并发症的发生情况.结果 ①超声刀组患者手术总时间（90±10）min]、全乳腺切除时间（50±10）min]、腋窝淋巴结清扫时间（39±5）min]均短于电刀组（120±10）min、（62±5）min、（57±10）min],差异有统计学意义（P＜0.05）.超声刀组患者出血量（50±10）mL]少于电刀组（1 10±10）mL],差异有统计学意义（P＜0.05）.②超声刀组Ⅰ～Ⅱ期患者腋窝淋巴结清扫手术时间（34±5）min]、出血量（40±10）mL]均低于电刀组（47±10）min、（81±10）mL],差异均有统计学意义（P＜0.05）;超声刀组Ⅲ期患者腋窝淋巴结清扫手术时间（46±5）min]、出血量（59±10）mL]均低于电刀组（68±10）min、（135±10）mL],差异均有统计学意义（P＜0.05）.③超声刀组术后24 h平均引流量（80±10）mL]、引流管放置时间（7±2）d]低于电刀组（140±10）mL、（12±2）d],差异均有统计学意义（P＜0.05）.④超声刀组发生皮下积液4例,电刀组发生皮下积液6例,组间比较差异无统计学意义（P＞0.05）.结论 超声刀在乳腺癌改良根治术中比单用电刀有明显的优势,在乳腺癌根治术中有很好的应用前景.

Clinical application of ultrasound activated scalpel in modified radical mastectomies

Objective To study the therapeutic effectiveness of ultrasound activated scalpel （UAS） in breast cancer operation.Methods A retrospective analysis was performed on 210 patients who received radical mastectomies in Central Hospital of Yangpu District from January 2010 to March 2013.The 210 patients were divided into two groups：110 cases were treated with UAS combined with high frequency electrotome （HFE） （USA group）,and 100 cases were treated with HFE only （HFE group）.Total operation time,whole breast removal time,axillary lymph node cleaning time,postoperative 24 h drainage volume,drainage tube placement time,and postoperative complications occurrence situation in the two groups were compared.Results ①Total operation time,whole breast removal time,axillary lymph node cleaning time in USA group （90±10） min,（50±10） min,（39±5） min] were all shorter than those in HFE group （120±10）min,（62±5） min,（57±10） min],the differences were statistically significant （P ＜ 0.05）.The bleeding amount in USA group （50±10） mL] was lower than that in HFE group （110±10） mL],the difference was statistically significant （P ＜0.05）.②Axillary lymph node cleaning time,bleeding amount in USA group of Ⅰ-Ⅱ stage （34±5） min,（40±10） mL] were all lower than those in HFE group （47±10） min,（81±10） mL],the differences were statistically significant （P ＜0.05）.Axillary lymph node cleaning time,bleeding amount in USA group of Ⅲ stage （46±5） min,（59±10） mL] were lower than those in HFE group （68±10） min,（135±10） mL],the differences were statistically significant （P ＜ 0.05）.③Postoperative 24 h drainage volume,drainage tube placement time （80±10）mL,（7±2） d] were all lower than those in HFE group （140±10） mL,（12±2） d],the differences were statistically significant （P ＜ 0.05）.④4 cases with subcutaneous hydrops in USA group,6 cases with subcutaneous hydrops in HFE group were found,the difference was not statistically significant （P ＞ 0.05）.Conclusion UAS in modified radical mastectomies have significant advantages,it has a good application prospect in modified radical mastectomies.