Douay N, Akerman G, Clément D, Malartic C, Morel O, Barranger E
Service de gynécologie-obstétrique, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris (AP-HP), 2, rue Ambroise-Paré, 75010 Paris, France.
Service de gynécologie-obstétrique, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris (AP-HP), 2, rue Ambroise-Paré, 75010 Paris, France.
Gynecol Obstet Fertil. 2008 Feb;36(2):130-135. doi: 10.1016/j.gyobfe.2007.07.040.
Since the advent of sentinel node biopsy, which made it possible to reduce the morbidity of axillary surgery, axillary lymph node dissection has been constituting the treatment of reference in certain cases of breast cancer. One of the most frequent complications in the immediate postoperative period is the lymphocele or seroma, the frequency of which is independent of the axillary technique of surgery. Following an analysis of the literature, some risk factors were isolated such as a high body mass index, the high volume of the first three days drainage and arterial hypertension. Some techniques seem to show a benefit in the reduction of the lymphocele: sentinel node biopsy, padding of the axilla and the axillary drainage. The majority of other techniques such as the use of fibrin sealant, hemolymphostatic sponges, various techniques of axillary dissection, external axillary compression, differed mobilization from the upper limb, axillary dissection by lipo-aspiration and endoscopic axillary dissection, have too contradictory results at the present time to be recommended in clinical practice. No consensus is clearly established to decrease the incidence and the volume of the seroma after axillary dissection in breast cancer. Today, two techniques can be nevertheless distinguished: sentinel node biopsy and padding of the axilla.
自从前哨淋巴结活检问世，使得降低腋窝手术的发病率成为可能以来，腋窝淋巴结清扫术在某些乳腺癌病例中一直是参考治疗方法。术后早期最常见的并发症之一是淋巴囊肿或血清肿，其发生率与腋窝手术技术无关。通过对文献的分析，发现了一些风险因素，如高体重指数、术后头三天的高引流量和动脉高血压。一些技术似乎在减少淋巴囊肿方面有好处：前哨淋巴结活检、腋窝填充和腋窝引流。目前，大多数其他技术，如使用纤维蛋白封闭剂、止血海绵、各种腋窝清扫技术、腋窝外部压迫、上肢不同的活动度、吸脂腋窝清扫和内镜腋窝清扫，其结果相互矛盾，无法在临床实践中推荐使用。目前尚无明确的共识来降低乳腺癌腋窝清扫术后血清肿的发生率和体积。不过，如今有两种技术可以区分：前哨淋巴结活检和腋窝填充。
