超声刀在乳腺癌根治术中的临床应用研究

目的　通过超声刀和电刀在乳腺癌改良根治手术的对比 ,探讨超声刀在乳腺癌改良根治术中的临床应用价值。方法　观察我院 2 0 0 1年 6月～ 2 0 0 4年 2月乳腺癌改良根治术病人 10 5例 ,47例采用电刀 ,为电刀组 ;5 8例采用超声刀 ,为超声刀组。主要观察指标有 :手术时间、术中出血量、术中输血例数、术后 2 4h引流量、放置引流管时间 ,以及术后并发症皮瓣坏死、皮下积液的观察对比。结果　超声刀组手术时间较电刀组有明显缩短 (P <0 .0 5 ) ;超声刀组平均节省手术时间 41.8min。术中平均出血量超声刀组较电刀组显著减少 (P <0 .0 0 1) ,超声刀组平均减少出血量 94.2ml。超声刀组术后 2 4h引流量较电刀组显著减少 (P <0 .0 0 1。超声刀组引流管放置时间较电刀组明显缩短 (P <0 .0 0 1)。超声刀组与电刀组术中输血例数、术后皮瓣坏死和皮下积液均无统计学差异。乳腺癌改良根治术整个手术过程 ,包括剥离皮瓣、乳腺切除和腋窝清扫均可使用超声刀来完成 ,无 1例发生腋血管、肩胛下血管、胸背神经、胸长神经的损伤 ;而电刀组不适合作腋窝清扫。结论　超声刀在乳腺癌改良根治术中 ,手术时间明显缩短 ,术中出血量显著减少 ,术中视野清晰 ,术后引流量也明显减少 ,术后皮下积液和皮瓣坏死未见增多 ,有减少趋势 ,可行

The Use of Ultrasonically Activated Scalpel in Modified Radical Mastectomies

Objective To study the advantages of ultrasonically activatedscalpel (UAS) in modified radical mastectomies compared with electrosurgery. Methods Modified radical mastectomies were performed in 105 cases with breast cancer between June 2001 and Feb. 2004. Patients were divided into two groups: in UAS group (n=58), the operations were performed by using the Ultracision Harmonic Scalpel,in electrosurgery group (ELC, n=47) the operations were performed by monopolar electric scalpel. Age, sex and condition of the two groups were similar. Major indexes to observe and compare include: operating time, the estimated bleeding and blood transfusion during surgery, draining volume in the postoperative 24 hours, draining time and postoperative complications such as necrosis of skin flap and subcutaneous hematocele. Results Operation time of the UAS group were 41.8 min less than electrosurgery group, bleeding volume of the UAS group were 94.2ml less than the electrosurgery group, drain volume in the first 24 hours postoperatively of the UAS group were obviously less than the electrosurgery group, and their differences are significant. There were no differences in blood transfusion, skin flap necrosis and subcutaneous hematocele. The overall operation process of modified radical mastectomies, including skin flap stripping, mastectomy and clearing of axilla, could be performed with UAS. Injuries of axillary vessel, subscapular vessel, long thoracic nerve and thoracodorsal nerve did not happen, while it is well known that ELC could not be used to clear axilla.Conclusion Using UAS in modified radical mastectomies can remarkably save operating time, reduce bleeding volume during surgery and drain volume postoperatively. The incidences of skin flap necrosis and subcutaneous hematocele tend to be less. Injury of long thoracic nerve and thoracodorsal nerve did not happen. The Ultrasound-propelled incision and hemostasis were satisfactory, and can be used to clear axilla. It seems to be a new, excellent operation energy with more superiorities than ELC. It can be applied widely in radical mastectomies.