|
血清肿是乳房切除±腋窝淋巴结清扫术后最常见的并发症，可能继发感染、出血、伤口裂开、皮瓣坏死，故需常规放置伤口引流进行防治。既往研究发现，通过褥式缝合技术将皮瓣与下方肌肉紧密缝合，可以减少乳房切除±腋窝淋巴结清扫术后血清肿的发生率。 2019年5月29日，美国乳腺外科医师学会和肿瘤外科学会《肿瘤外科学报》在线发表荷兰天主教凯尼休斯医院和新教威廉敏娜医院、奈梅亨拉德堡德大学医疗中心的研究报告，探讨了褥式缝合可否安全地免去乳房切除±腋窝淋巴结清扫术后伤口引流。 该研究对2010年10月～2017年8月接受乳房切除±腋窝淋巴结清扫的251例患者进行回顾分析，其中褥式缝合放置引流85例、褥式缝合不放引流166例。主要结局为术后临床明显（需要液体抽吸或其他干预）血清肿的发生率，次要结局为术后感染、出血、伤口裂开、皮瓣坏死的发生率。 结果，不放引流与放置引流相比：
根据多因素分析，未见血清肿形成的显著预测因素。 因此，该研究结果表明，当褥式缝合用于乳房切除±腋窝淋巴结清扫时可免术后引流，有利于日间病房（当天即可出院，不用住院过夜）开展乳房切除术，避免引流相关护理、引流相关不适、引流相关费用。 Ann Surg Oncol. 2019 May 29. [Epub ahead of print] Omitting Postoperative Wound Drainage After Mastectomy With Skin-Flap Quilting. B. ten Wolde, F. F. R. Strobbe, M. Schlooz-de Vries, F. J. H. van den Wildenberg, M. Keemers-Gels, J. H. W. de Wilt, L. J. A. Strobbe. Canisius Wilhelmina Hospital, Nijmegen, The Netherlands; Radboud University Medical Centre, Nijmegen, The Netherlands. BACKGROUND: Seroma is the most frequent complication after mastectomy (ME) and axillary lymph node dissection (ALND). The quilting suture technique, in which skin flaps are sutured to the underlying muscle, was previously investigated and found to reduce seroma incidence after ME and ALND. This study aimed to investigate whether postoperative wound drainage can safely be omitted when quilting sutures are applied. METHODS: Two groups with a total of 251 consecutive patients who underwent ME, ALND, or both were retrospectively compared. The first group underwent quilting sutures with wound vacuum drainage, and the second group underwent quilting sutures without wound drainage. The primary outcome was the incidence of postoperative clinically significant seroma (CSS). The secondary outcomes were the incidence of postoperative infection, bleeding complications, wound dehiscence, and flap necrosis. RESULTS: The group without a postoperative drain (n=166) had a significantly lower CSS incidence (8.4%) than the group with a postoperative drain (n=85, 21.2%) (p<0.05). In the multivariate analysis, no significant predictors were found for seroma formation. Wound complications significantly decreased, from 31.8% in the group with a drain group to 17.5% in the group without a drain (p<0.05). CONCLUSION: This study showed that the postoperative drain can be omitted when quilting sutures are applied in ME, ALND, or both. This facilitates day care mastectomy, eliminating drain-related care, discomfort, and related expenses. DOI: 10.1245/s10434-019-07411-x
|
|
|
