Agrawal Amit, Ayantunde Abraham Abiodun, Cheung Kwok Leung
Professorial Unit of Surgery, Nottingham City Hospital, Nottingham, UK.
ANZ J Surg. 2006 Dec;76(12):1088-95. doi: 10.1111/j.1445-2197.2006.03949.x.
Seroma formation is the commonest early sequel to breast cancer surgery especially when axillary dissection is undertaken. It is associated with significant morbidity and financial burden. The main pathophysiology of seroma is still poorly understood and remains controversial. The optimal ways to reduce the incidence of seroma formation are unknown. The aim of this paper is to review the concepts of pathophysiology of seroma formation following mastectomy and breast-conserving surgery for cancer. The various techniques in practice to reduce its incidence and treatment are outlined.
MEDLINE search of published work on the subject with respect to its pathophysiology, prevention and treatment was carried out. Manual retrieval of relevant articles in the reference lists of the original papers from the MEDLINE was then carried out.
The pathophysiology and mechanism of seroma formation in breast cancer surgery remains controversial and not fully understood. Methods of prevention and treatment of seroma remain varied and inconclusive.
Evidence suggests an increase in the incidence of seroma because of thermal trauma from electrocautery dissection, but this is indispensable for surgical haemostasis. Obliteration of dead space by various flap apposition techniques has been shown to be advantageous in reducing incidence and volume of seroma. Low-pressure suction drainage reduces seroma volume and duration of drainage leading to earlier drain removal. Preventive measures have to be tailored according to individual patient and operative factors.
血清肿形成是乳腺癌手术后最常见的早期后遗症，尤其是在进行腋窝淋巴结清扫时。它会导致明显的发病率和经济负担。血清肿的主要病理生理学仍未得到充分理解，且存在争议。降低血清肿形成发生率的最佳方法尚不清楚。本文旨在综述乳腺癌根治术和保乳手术后血清肿形成的病理生理学概念。概述了实践中降低其发生率的各种技术及治疗方法。
通过医学文献数据库（MEDLINE）检索关于血清肿病理生理学、预防和治疗的已发表研究。然后手动检索MEDLINE原始论文参考文献列表中的相关文章。
乳腺癌手术中血清肿形成的病理生理学和机制仍存在争议，尚未完全明确。血清肿的预防和治疗方法多样且尚无定论。
有证据表明，电灼分离造成的热损伤会增加血清肿的发生率，但这对于手术止血是必不可少的。采用各种皮瓣贴合技术消除死腔已被证明有利于降低血清肿的发生率和减少其体积。低压吸引引流可减少血清肿体积和引流持续时间，从而使引流管更早拔除。预防措施必须根据个体患者和手术因素进行调整。
