Throckmorton Alyssa D, Askegard-Giesmann Johanna, Hoskin Tanya L, Bjarnason Haraldur, Donohue John H, Boughey Judy C, Degnim Amy C
Department of Surgery, Mayo Clinic, Rochester, MN, USA.
Am J Surg. 2008 Oct;196(4):541-4. doi: 10.1016/j.amjsurg.2008.06.020.
Seroma is a common complication after mastectomy. We review our experience with sclerotherapy for postmastectomy seroma management.
Patients who underwent outpatient sclerotherapy for postmastectomy seroma were reviewed. Ninety-five percent ethyl alcohol or povidone iodine, which was administered by way of percutaneous catheter, was the initial sclerosant, and dwell time was 20 to 30 minutes. Povidone iodine solution was instilled 2 to 3 times daily. Catheters were removed when output reached <30 mL/d or when cavity size was <20 ml by sinogram.
Sixteen patients (18 seromas) had sclerotherapy initiated at median of 34 days after surgery. Mean number of treatment days was 3 (median duration 16). Seven patients (44%) developed infection during treatment, which was associated with increased duration. Three seromas recurred and were successfully treated with single aspiration.
Sclerotherapy is a feasible treatment for chronic seroma after mastectomy. Longer treatment duration was associated with infection; antibiotic prophylaxis should be considered. Research is necessary to determine optimal regimens and superiority over other approaches.
血清肿是乳房切除术后常见的并发症。我们回顾了我们在采用硬化疗法治疗乳房切除术后血清肿方面的经验。
对接受门诊硬化疗法治疗乳房切除术后血清肿的患者进行了回顾。通过经皮导管注入的95%乙醇或聚维酮碘是初始硬化剂，停留时间为20至30分钟。聚维酮碘溶液每天注入2至3次。当引流量降至<30 mL/天或通过造影显示腔隙大小<20 ml时，拔除导管。
16例患者（18处血清肿）在术后中位34天开始接受硬化疗法。平均治疗天数为3天（中位持续时间16天）。7例患者（44%）在治疗期间发生感染，这与治疗持续时间延长有关。3处血清肿复发，通过单次抽吸成功治疗。
硬化疗法是治疗乳房切除术后慢性血清肿的一种可行方法。治疗持续时间延长与感染有关；应考虑预防性使用抗生素。有必要开展研究以确定最佳方案以及相对于其他方法的优势。
