Gonzalez Ernest A, Saltzstein Edward C, Riedner Carola S, Nelson Brian K
Department of Surgery, Texas Tech University Health Sciences Center, El Paso, Texas 79905, USA.
Breast J. 2003 Sep-Oct;9(5):385-8. doi: 10.1046/j.1524-4741.2003.09504.x.
A seroma is the most frequent complication of breast cancer surgery, the etiology of which remains obscure. We reviewed our data to determine the factors related to the incidence of seroma formation in our patients. A retrospective analysis of the records of 359 consecutive patients (334 Hispanic; 93%) who underwent primary surgical therapy from January 1, 1996 to December 31, 2000, with either modified radical mastectomy (MRM) or wide local excision (WLE) and axillary lymph node dissection (ALND) was performed. In all cases, removal of the breast was performed using electrocoagulation, and sharp dissection was used in the axilla. One-eighth inch closed suction round drains were used. Early arm motion was encouraged. The seroma rate was compared to the age of the patient, the presence and number of positive axillary lymph nodes, the total number of axillary lymph nodes removed, tumor size, weight of the patient, the use of neoadjuvant chemotherapy, and the type of surgery performed. The overall seroma rate was 15.8%. Seromas occurred in 19.9% of patients undergoing MRM and in 9.2% of patients undergoing breast-conserving surgery (p=0.01). The seroma rate was not influenced by any other tested variables. All seromas were easily managed with aspiration and pressure; this technical maneuver allowed seroma resolution in all patients except one following one to six aspirations. A seroma did not delay initiation of chemotherapy. No patient developed a capsule requiring excision. In our experience, a seroma is a "necessary evil;" it will occur unpredictably in a predictable number of patients.
血清肿是乳腺癌手术最常见的并发症，其病因尚不清楚。我们回顾了我们的数据，以确定与我们患者血清肿形成发生率相关的因素。对1996年1月1日至2000年12月31日期间连续接受初次手术治疗的359例患者（334例西班牙裔；93%）的记录进行了回顾性分析，这些患者均接受了改良根治性乳房切除术（MRM）或广泛局部切除术（WLE）以及腋窝淋巴结清扫术（ALND）。在所有病例中，均使用电凝法切除乳房，并在腋窝使用锐性分离术。使用八分之一英寸的封闭式负压圆形引流管。鼓励早期进行手臂活动。将血清肿发生率与患者年龄、腋窝阳性淋巴结的存在及数量、切除的腋窝淋巴结总数、肿瘤大小、患者体重、新辅助化疗的使用以及所进行的手术类型进行了比较。总体血清肿发生率为15.8%。接受MRM的患者中血清肿发生率为19.9%，接受保乳手术的患者中血清肿发生率为9.2%（p=０.０１）。血清肿发生率不受任何其他测试变量的影响。所有血清肿通过抽吸和加压都很容易处理；这种技术操作使除1例患者外的所有患者在进行1至6次抽吸后血清肿均得以消退。血清肿并未延迟化疗的开始。没有患者出现需要切除的包膜。根据我们的经验，血清肿是一种“难以避免的不良后果”；它会在可预测数量的患者中不可预测地发生。
