| ObjectiveTo analyze the main influencing factors and prevention measures of subcutaneous effusion after modified radical mastectomy of breast cancer,to observe the total drainage volume,drainage time and the incidence of subcutaneous hydrops after axillary lymph node dissection after radical mastectomy,to investigate the effect of axillary hemorrhage after breast cancer surgery with gelatin sponge,absorbable hemostatic gauze and mannatide.MethodsClinical date were collected from 215 cases of breast cancer,the patients who were confirmed by pathological examination and accepted modified radical mastectomy of breast cancer,are collected from January 2014 to December 2016 of breast surgery department in affiliated hospital of Taishan Medical University.All included patients were female,aged 29-74 years old,mean(51.2 ± 6.5)years;The tumor was located in the left breast 112 cases(52.09%),and in the right breast 103 cases(47.91%);Premenopausal 89 cases(41.40%),126 cases(58.60%)of postmenopausal;Pathological results: TNM staging stage?70 cases(32.56%),stage?106 cases(49.30%),stage?39 cases(18.14%);Tumor size ?2cm 38 cases(17.67%),2-5cm 177 cases(82.33%);Lymph node metastasis none 112 cases(52.09%),1-3 pieces 67 cases(31.16%),4-9 pieces 25 cases(11.63%),?10 pieces 11 cases(5.12%);Immunohistochemical features: ER(-)59 cases(27.44%),(+)35 cases(16.28%),(++)26 cases(12.09%),(+++)95 cases(44.19%);PR(-)77 cases(35.81%),(+)45 cases(20.93%),(++)38 cases(17.67%),(+++)55 cases(25.58%);Her-2(-)87 cases(40.47%),(+)56 cases(26.05%),(++)34 cases(15.81%),(+++)38 cases(17.67%);Ki-67(-)112 cases(52.09%),(+)38 cases(17.67%),(++)44 cases(20.47%),(+++)21 cases(9.77%);Pathological typing: infiltrating ductal carcinoma 157 cases(73.02%),infiltrating lobular carcinoma 33 cases(15.35%),other types 25 cases(11.63%).According to the different biological materials used in the operation,the patients were divided into groups: gelatin sponge group,a total of 76 patients,who were treated with 2-4 pieces gelatin sponge filled in lymph node dissection and around the axillary vessels after injection water and normal saline;hemostatic gauze group,a total of 61 patients,who were treated with 2-4 pieces hemostatic gauze filled in lymph node dissection and around the axillary vessels after injection water and normal saline;mannatide group,a total of 45 patients,the use of mannatide spray lymph node dissection and peripheral vascular wound after injection water and normal saline;saline group,a total of 33 cases,who were treated with injection water and normal saline without other special treatment.The volume of subcutaneous drainage,drainage time and the rate of subcutaneous hydrops after extubation were recorded,and the data were processed by SPSS20.0 statistical software package.ResultsA total of 215 patients undergoing modified radical mastectomy of breast cancer were analyzed.Comparison of total drainage after operation: The total flow volume of the patients in the saline group was(430.89±76.89)ml,and the gelatin sponge group was(380.28±45.74)ml,the hemostatic group was(320.55±40.59)ml,and the mannan peptide group was(397.39±50.48)ml.The total drainage volume of the patients using biological materials in each group was lower than that in the saline group,the difference was statistically significant(P=0.00).The total drainage volume of hemostatic group was lower than that of gelatin sponge group and mannan peptide group,and the difference was statistically significant(P<0.01).The total drainage of gelatin sponge group was lower than that of mannan peptide group,but the statistical analysis showed that there was no significant difference between the two groups(P>0.05).Among them,the effect of hemostatic thread is the best.Comparison of drainage time: The drainage time of the saline group was(13.25±3.58)d,and the gelatin sponge group was(9.24±2.88)d,the hemostatic group was(6.78±1.85)d,and the mannan peptide group was(9.85±2.56)d.The drainage time of each group of patients using biological materials was shorter than that of the saline group,and the difference was statistically significant(P = 0.00).Compared with the gelatin sponge group and the mannan group,the drainage time of the hemostatic group was more obvious,and the difference was statistically significant(P<0.01).And the statistical analysis showed that there was no significant difference between the gelatin sponge group and the mannan peptide group(P>0.05).Among them,the effect of hemostatic thread is the best.Comparison of the incidence of subcutaneous hydrops: There were 23 cases of sub-cutaneous hydrops in saline group,accounting for 69.7%,25 cases in gelatin sponge group,accounting for 32.9%,5 cases in hemostatic group,accounting for 8.2%,and 14 cases in mannan group,accounting for 31.1%.The incidence of subcutaneous hydrops in each group of patients using biological materials was lower than that in saline group,and the difference was statistically significant(P = 0.00).The incidence of subcutaneous hydrops in the hemostatic group was significantly lower than that in the gelatin sponge group and the mannan peptide group,and the difference was statistically significant(P<0.0042).The rate of subcutaneous hydrops in gelatin sponge group was higher than that in mannan group,but the statistical analysis showed that the difference between the two groups was not statistically significant(P = 0.84).Among them,the effect of hemostatic thread is the best.Conclusion1.Unobstructed subcutaneous drainage after modified radical mastectomy is the key measure to prevent the complications such as subcutaneous fluid accumulation and bad healing of incision.2.The increase of axillary drainage and prolonged drainage time after breast cancer affect the patient's condition seriously,shorten the drainage time and reduce the flow rate,which can significantly improve the quality of life of the patients.3.The treatment of axillary wounds with biomaterials can significantly reduce the amount of postoperative drainage and shorten the drainage time,reduce the incidence of subcutaneous hydrops.4.In the radical mastectomy,the biological materials such as gelatin sponge,hemostatic thread and mannan peptide placed in the armpit can accelerate the recovery of the patient.Among them,the effect of hemostatic thread is better,and the effect of gelatin sponge and mannan peptide has little difference. |
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