Petrek J A, Peters M M, Cirrincione C, Thaler H T
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021.
Surg Gynecol Obstet. 1992 Nov;175(5):405-9.
Increasing duration and amount of postoperative fluid formation after axillary lymphadenectomy delays final healing. We postulated that multiple drains (instead of a single drain) might decrease postoperative fluid accumulation by their greater proximity to points of leakage. We randomized 65 women with clinical stage I or II carcinoma of the breast to single or multiple drains. They were stratified for axillary dissection or modified radical mastectomy. For axillary dissection, randomization to multiple drains meant placement of four catheters in the axilla, and randomized to the single drain, one catheter in the axilla. For modified radical mastectomy, the patients randomized to multiple drains received four catheters in the axilla and one catheter under the inferior flap; the patients randomized to single drains had one catheter in the axilla and one catheter under the inferior flap. All catheters exited separately. The two arms (single versus multiple drains) were determined to be homogeneous in other variables that may affect postoperative fluid formation--age, size of the breast, weight, height, obesity, presence of previous surgical biopsy, excision of pectoralis minor muscle, excision of thoracodorsal complex, level of axillary dissection, number of lymph nodes, number and proportion of positive lymph nodes and whether or not the dominant hand was on the side operated upon. Single versus multiple drains had no clinically significant effect on the amount or duration of drainage, as an inpatient or outpatient, or total. We recommend a single drain to the axilla after lymphadenectomy.
腋窝淋巴结清扫术后，术区积液时间延长和积液量增加会延迟最终愈合。我们推测，多根引流管（而非单根引流管）可能因其更靠近漏液点而减少术后积液。我们将65例临床I期或II期乳腺癌女性患者随机分为单根引流管组或多根引流管组。根据腋窝清扫或改良根治性乳房切除术进行分层。对于腋窝清扫术，随机分配至多根引流管组意味着在腋窝放置4根导管，随机分配至单根引流管组则在腋窝放置1根导管。对于改良根治性乳房切除术，随机分配至多根引流管组的患者在腋窝接受4根导管，并在皮瓣下方接受1根导管；随机分配至单根引流管组的患者在腋窝有1根导管，在皮瓣下方有1根导管。所有导管均单独引出。在可能影响术后积液形成的其他变量方面，两组（单根引流管组与多根引流管组）被确定为同质——年龄、乳房大小、体重、身高、肥胖情况、既往手术活检史、胸小肌切除情况、胸背复合体切除情况、腋窝清扫范围、淋巴结数量、阳性淋巴结数量及比例，以及优势手是否位于手术侧。单根引流管与多根引流管在住院或门诊引流的量或持续时间，或总体引流情况方面，均无临床显著影响。我们建议腋窝淋巴结清扫术后在腋窝放置单根引流管。
