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 80例采用改良乳腺癌根治术患者被分为两组.2004年1月至2007年1月48例作为对照组(改良乳腺癌根治术切口采用Stewart切口或纵切口,且术后不使用丹参和医用伤口护理膜);2007年1月至2010年1月32例作为研究组(手术切口采用改良Stewart切口,在改良乳腺癌根治术后使用丹参和医用伤口护理膜).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31.25℅,而研究组是9.37℅,两组间有显著差异﹙P﹤0.05﹚.结论 采用Z形切口设计,合理的皮瓣厚度,避免皮瓣张力,防止淋巴管漏,有效的双管引流,合理包扎及丹参、医用伤口护理膜的使用均是预防改良乳腺癌根治术后皮瓣坏死的关键.

Prevention of skin flap necrosis following modified radical operation of breast cancer

Objective To study how to reduce the incidence of skin flap necrosis after modified radical operation of breast cancer. Methods Eighty cases received modified radical operation of breast cancer were divided into two groups： 48 cases （ control group） received surgery with Stewart incision or longitudinal incision between January 2004 and January 2007, 32 eases （ study group） received surgery with modified Stewart incision between January 2007 and January 2010. The patients in study group and control group were treated with or without Salvia miltiorrhiza Bge and medical wound care membrane respectively after surgery. The postoperative necrosis of skin flaps were compared between the two groups. Results The incidences of postoperative necrosis of skin flaps were 31.25% and 9.37% in control group and study group respectively. There was significant difference between the two groups. Conclusion In the modified radical operation of breast cancer, the keys to prevent the necrosis of skin flaps are incision devise, proper thickness of skin flap, perfect suture without tension, prevention of lymphatic leakage, effective double tube drainage, suitable bandaging and the uses of Salvia miltiorrhiza Bge and medical wound care membrane.