Okada Naoya, Narita Yoshiaki, Takada Minoru, Kato Hiroaki, Ambo Yoshiyasu, Nakamura Fumitaka, Kishida Akihiro, Kashimura Nobuichi
Department of Surgery, Teine Keijinkai Hospital, 1-12 Maeda, Teine-ku, Sapporo, 006-8555, Japan,
Breast Cancer. 2015 Jan;22(1):79-83. doi: 10.1007/s12282-013-0457-3. Epub 2013 Mar 14.
Women undergoing surgery for primary breast cancer routinely have suction drains inserted deep to the wounds. A lack of data exists in relating how long suction drains should stay in situ after major breast surgery.
This study evaluates the appropriate timing of drain removal by comparing the 5-day-long postoperative drainage or drain removal when less than 50 mL/24 h to conventional drain removal.
This controlled clinical trial was undertaken between February 1997 and May 2012 with a total of 214 consecutive patients who underwent elective total or partial mastectomy with level II axillary lymph node dissection. The main outcome measures included the length of hospital stay, and surgical morbidity, especially seroma formation.
In the study group, the age and operation time were significantly increased compared to the conventional group whereas the median hospital stay was significantly shorter in the study group than the control group (7 days vs. 9 days; p < 0.05). The incidence of seroma was 42.8 % in the study group and 31.6 % in the control group (p = 0.14). The mean number of outpatient visits for seroma was 3.6 in the study group and 1.5 in the control group (p < 0.05). Drainage volume of more than 150 mL/24 h all resulted in seroma formation.
The new criteria for early drain removal are safe and acceptable despite the slightly increased chance of seroma formation.
接受原发性乳腺癌手术的女性通常会在伤口深处插入负压引流管。目前缺乏关于负压引流管在乳房大手术后应留置多长时间的数据。
本研究通过比较术后5天引流或引流量小于50 mL/24小时时拔除引流管与传统引流管拔除方式，评估引流管拔除的合适时机。
本对照临床试验于1997年2月至2012年5月进行，共有214例连续患者接受了择期全乳或部分乳房切除术及II级腋窝淋巴结清扫术。主要观察指标包括住院时间和手术并发症，尤其是血清肿形成情况。
研究组患者年龄和手术时间均显著高于传统组，而研究组的中位住院时间显著短于对照组（7天对9天；p<0.05）。研究组血清肿发生率为42.8%，对照组为31.6%（p=0.14）。研究组血清肿门诊平均就诊次数为3.6次，对照组为1.5次（p<0.05）。24小时引流量超过150 mL均导致血清肿形成。
尽管血清肿形成几率略有增加，但早期拔除引流管的新标准是安全且可接受的。
