乳腺癌术后皮瓣坏死原因分析和防治措施的探讨

目的　分析乳腺癌术后皮瓣坏死的原因及探讨防治措施。方法　对14 2例乳腺癌患者术后的临床资料进行总结,回顾性分析患者年龄、手术方式、切口选择、皮瓣厚度、皮瓣张力、手术刀或高频电刀游离皮瓣、单纯性持续中心负压吸引或持续中心负压吸引加弹力绷带加压包扎与皮瓣坏死程度的关系。结果　14 2例乳腺癌患者中,术后皮瓣坏死2 7例,占19.0 1%。皮瓣坏死与切口选择、皮瓣厚度和皮瓣张力有关(P <0 .0 5 )。采用横梭形切口(8.82 % ,3 /3 4)、厚皮瓣(17.3 5 % ,17/98)、低张力皮瓣(7.81% ,5 /64 )者的皮瓣坏死发生率分别较纵梭形切口(2 2 .11% ,2 1/95 )或斜梭形切口(2 3 .0 8% ,3 /13 )、薄皮瓣(2 2 .73 % ,10 /4 4)和高张力皮瓣(2 8.2 1% ,2 2 /78)者低,有显著性差异(P <0 .0 5 )。结论　乳腺癌术后皮瓣坏死原因是多方面的,皮瓣供血不足是术后皮瓣坏死的根本原因。合理的选择手术切口,选择适当厚度的皮瓣,术中慎用电刀,无张力缝合,保护皮瓣血运,术后持续中心负压吸引,适当加压包扎等是防治皮瓣坏死的关键措施。

Analyse Causes of Skin Flap Necrosis after Operation of Breast Cancer, Explore its Preventive and Theraphy Measures

Objective Analyse Causes of Skin Flap Necrosis after Operation of Breast Cancer,Explore its Preventive and theraphy Measures.Methods The clinical dates of 142 breast cancer patients received surgery operation treatment was analysed retrospectively.Studied the relations between the pateins,years old,the mode of the operation,the selection of incision,the thickness of the skin flap,tension of the skin flap,using lancet or eletric knife free incision skin flap,semplice durative center negative atmospheric pressure suction or semplice durative center negative atmospheric pressure suction bind with enswathement by pressure and the necrosis degree of the skin flap.Results There were 27 cases(19.01%) suffured from skin flap necrosis among 142 breast cancer cases received surgery operation.The skin flap necrosis was related with the selection of incision,the thickness of the skin flap and tension of the skin flap(P<0.05).The rate of the flap necrosis in transverse incision(8.82%,3/34),the thick skin flap(17.35%,17/98),the low tension(7.81%,5/64)group were lower than longitudinal(22.11%,21/95) or oblique incision(23.08%,3/13),the thin skin flap(22.73%,10/44),the high flap tension(28.21%,22/78) group and there was significant difference(P<0.05).Conclusion After breast cancer surgery operation,the causes of necrosis of skin flap are various,that of the basic cause is that the skin flap is short of blood transportment.So,the skin flap of blood transport should be protected during operation,select suitable operation incision,adequacy the thickness of the skin flap,carefully using eletric knife,no tension when stitching of the skin incision,protect skin flap of blood transportment,and after operation durative center negative atmospheric pressure suction,the chest should be packed properly and so on were keys of preventing skin flap necrosis.