乳腺癌根治430例手术区域早期并发症81例治疗体会.docVIP

乳腺癌根治430例手术区域早期并发症81例治疗体会【摘要】 目的 探讨乳腺癌根治430例手术区域早期并发症81例(占18.8%)的最佳治疗。方法 81例患者均为女性,其中61例实施改良根治,20例行标准根治(包括1例双乳)手术区域出现皮下积液51例;大出血3例;皮瓣不同程度缺血坏死27例。结果 其中3例术后大出血二次手术清除积血,严密止血;51例积液皮瓣网状小切口多管引流,加压包扎。27例皮缘坏死切除二期缝合,部分皮瓣坏死切除中厚皮片移植等均获得较好的临床效果。结论 笔者认为,早期治疗局部并发症使创面愈合为患者争取了早期综合治疗的机会。 【关键词】乳癌根治;手术区域;早期并发症 The treatment experiences of 430 radical mammary cancer patients in which 81early complication patients WANG Guiqing WANG Pei,FAN Jinyu.Surgical oncology of Xinyang Municipal Central Hospital,Henan,464000,China 【Abstract】 Objective Exploring the best treatment methord of 430 radical mammary cancer patients in which 81 patients(18.8%)operative region early complication.Methods All the 81 patients are females,in which 61 patients carry out improving radical cure,20 patients carry out standard radical cure(include 1 patient breasts).51 patients operative region appear subcutaneous effusion;3 patients appear hemorrhea; 27 patients skin flap ischemia and necrosis differ in degree.Results 3 patients hemorrhea after operation and then were operated again to be clean out hematocele,and intensive hemostasis; 51 patients were carry out effusion skin flap reticulate miniopen manidoldtype drainage and pressure dressing.27 patients cuticular border necrosis excision secondary suture.we get very good clinical effect in partial skin flap necrosis excision thickskinned transplant etc.Conclusion Writers think early curing local complication,making wound healing is good; it wins early comprehensive cure opportunity for patients. 【Key words】Radical mammary;Cancer operative;Region early complication 乳腺癌标准或改良根治,手术范围创伤大,创面广,皮下积液和皮瓣坏死都是临床最常见的早期并发症,严重影响患者术后恢复过程。住院时间长,经济负担重,思想压力大。直接影响患者术后放化疗的实施,笔者对81例乳腺癌患者,术后皮下积液,皮瓣坏死者经早期积极综合治疗后,积液很快消失,皮瓣伤口在最短的时间完全愈合。 1 临床资料 1.1 一般资料 本科自2004年5月至2009年5月共施行乳腺癌根治430例,其中手术区域积血积液,皮瓣坏死81例(占18.8%)均为女性,年龄22~93岁,平均56岁。国际TNM分期:Ⅰ期18例;Ⅱ期42例;Ⅲ期17例;Ⅳ期4例。术前术后均病理确诊。 1.2 手术方法 标准根治20例(包括1例双乳)改良根治61例。手术切口纵梭状73例,横梭状7例,纵梭状加原位健康全厚皮回植1例(外上象限肿瘤溃烂皮肤严重缺损,利用纵梭状切除,乳头下方健康