Unit of General and Geriatric Surgery, Department of Medical, Surgical, Neurological, Metabolic and Ageing Sciences, Second University of Naples, Piazza Miraglia 5, 80138 Naples, Italy.
Int J Surg. 2014 Nov;12(11):1210-5. doi: 10.1016/j.ijsu.2014.10.005.
Breast cancer surgery with axillary lymphadenectomy may be associated with prolonged stay of the drain in the axilla due to high wound output, which may require further treatments and prolong the length of stay, impairing quality of life. No definitive data are available concerning how to prevent this complication. Our aim was to assess the efficacy of a new low-thrombin fibrin glue in reducing the serous output from the axillary surgical wound in patients undergoing axillary node dissection for breast cancer, and its long-term effects on lymphedema.
Sixty patients undergoing surgery between September 2012 and June 2013 were enrolled. Thirty patients received Artiss®(Baxter, UK) fibrin glue plus drainage, and 30 drainage alone. A multivariate analysis was performed to identify predictors of seroma, and subgroup analyses were performed. Lymphedema was assessed 12 months after surgery.
Patients who received fibrin glue had reduced serum output collected in the drain after surgery (94.3 ± 22.4 vs 176 ± 24.6 ml p < 0.001) and shorter length of postoperative hospital stay (p = 0.001). Incidence of seroma at 4-week follow-up did not differ between groups. At multivariate analysis, BMI ≥ 30 kg/m(2) was the only independent predictor of seroma formation (OR = 2.7, 95%CI 1.4-5.3; p = 0.002). Overweight patients receiving Artiss® had fewer seroma at 4-week follow-up compared with control overweight patients (0% vs 55.6%, p = 0.03). No differences were observed in lymphedema between groups (6.7% vs 10%, p > 0.99).
Low-thrombin fibrin glue reduced the amount of fluid produced in the axilla after breast surgery. Overweight patients may be the ideal candidates for this treatment. Such sealant did not increase the rates of lymphedema.
乳腺癌手术伴腋窝淋巴结清扫术可能会由于高伤口渗出而导致引流管在腋窝中留置时间延长，这可能需要进一步的治疗并延长住院时间，从而影响生活质量。目前尚无关于如何预防这种并发症的明确数据。我们的目的是评估新型低凝血酶纤维蛋白胶在减少乳腺癌腋窝淋巴结清扫术后腋窝手术伤口浆液性渗出方面的疗效，及其对淋巴水肿的长期影响。
2012 年 9 月至 2013 年 6 月期间共纳入 60 例患者。其中 30 例患者接受 Artiss®（Baxter，英国）纤维蛋白胶联合引流治疗，30 例仅接受引流治疗。采用多变量分析确定血清肿的预测因素，并进行亚组分析。术后 12 个月评估淋巴水肿。
接受纤维蛋白胶治疗的患者术后引流收集的血清量减少（94.3±22.4 与 176±24.6 ml，p<0.001），术后住院时间缩短（p=0.001）。两组在 4 周随访时的血清肿发生率无差异。多变量分析显示，BMI≥30 kg/m²是血清肿形成的唯一独立预测因素（OR=2.7，95%CI 1.4-5.3；p=0.002）。超重患者接受 Artiss®治疗的 4 周随访时血清肿发生率低于对照组超重患者（0%与 55.6%，p=0.03）。两组间淋巴水肿无差异（6.7%与 10%，p>0.99）。
低凝血酶纤维蛋白胶可减少乳腺癌手术后腋窝的液体生成量。超重患者可能是这种治疗的理想人选。这种密封剂不会增加淋巴水肿的发生率。
