Ul-Mulk Jamshaid, Hölmich Lisbet Rosenkrantz
Plastikkirurgisk Afdeling, Herlev Hospital, Herlev Ringvej 75, 2730 Herlev, Denmark.
Dan Med J. 2012 Jun;59(6):A4441.
Malignant melanoma is one of the most rapidly increasing cancer types globally, and it is by far the most serious skin cancer. Patients with a melanoma ≥ 1 mm in Breslow thickness are offered sentinel node (SN) biopsy and subsequent radical lymph node dissection if the biopsy is positive. The objective in the present paper was to describe post-operative complications in this group of patients. A standard operation and drainage regime was used.
This was a retrospective study based on 96 consecutive SN-positive patients with primary cutaneous malignant melanoma who underwent subsequent radical axillary or inguinal lymph node dissection. Fisher's exact test and Mann-Whitney U-test were used to evaluate associations.
In all, 57 patients were male and 39 female. A total of 71 had an axillary and 25 an inguinal operation. The median drainage period was seven days (2-15 days). Forty patients developed seroma which needed puncture; three of these cases were chronic, there was no difference between the two groups. Seroma puncture was only associated with infection in the inguinal group (p = 0.04). 25% in the axillary group were diagnosed with lymph oedema after three months versus 48% in the inguinal group (p = 0.04). A body mass index ≥ 25 kg/m2 was associated with a slight, but non-significant increase in complications (p = 0.08). No association was found for smoking or co-morbidity.
Patients undergoing axillary or inguinal lymph node dissection experience a significant number of complications, especially seroma and lymph oedema. Long-term complications are severe and can profoundly impact the patient's quality of life.
恶性黑色素瘤是全球发病率增长最为迅速的癌症类型之一，也是迄今为止最严重的皮肤癌。对于 Breslow 厚度≥1mm 的黑色素瘤患者，如果前哨淋巴结（SN）活检呈阳性，则需进行前哨淋巴结活检及后续根治性淋巴结清扫术。本文旨在描述该组患者的术后并发症情况。采用了标准的手术及引流方案。
这是一项回顾性研究，纳入了 96 例连续的原发性皮肤恶性黑色素瘤 SN 阳性患者，这些患者随后接受了根治性腋窝或腹股沟淋巴结清扫术。采用 Fisher 精确检验和 Mann-Whitney U 检验评估相关性。
总共 57 例男性，39 例女性。71 例接受腋窝手术，25 例接受腹股沟手术。中位引流期为 7 天（2 - 15 天）。40 例患者出现血清肿，需要穿刺；其中 3 例为慢性血清肿，两组之间无差异。血清肿穿刺仅与腹股沟组的感染相关（p = 0.04）。腋窝组 25%的患者在三个月后被诊断为淋巴水肿，而腹股沟组为 48%（p = 0.04）。体重指数≥25kg/m²与并发症略有增加但无显著相关性（p = 0.08）。未发现吸烟或合并症与并发症有关。
接受腋窝或腹股沟淋巴结清扫术的患者会出现大量并发症，尤其是血清肿和淋巴水肿。长期并发症严重，会对患者的生活质量产生深远影响。
