使用组织胶水或缝线固定皮瓣似乎可减少乳腺癌乳房切除术后的血清肿抽吸。

Flap Fixation Using Tissue Glue or Sutures Appears to Reduce Seroma Aspiration After Mastectomy for Breast Cancer.

作者信息

van Bastelaar James, Theunissen Lotte L B, Snoeijs Maarten G J, Beets Geerard L, Vissers Yvonne L J

机构信息

Department of Surgery, Orbis Medical Center, Sittard, the Netherlands; Department of Surgery, Atrium Medical Center, Heerlen, the Netherlands; Zuyderland Medical Center (the merger of Atrium Medical Center and Orbis Medical Center), Heerlan, the Netherlands.

Department of Surgery, Orbis Medical Center, Sittard, the Netherlands.

出版信息

Clin Breast Cancer. 2017 Jul;17(4):316-321. doi: 10.1016/j.clbc.2017.01.005. Epub 2017 Jan 24.

DOI:10.1016/j.clbc.2017.01.005

PMID:28202253

Abstract

BACKGROUND

Up to 90% of patients undergoing breast cancer surgery suffer from seroma formation, which can cause discomfort and various complications after mastectomy. This retrospective observational cohort study aimed to elucidate whether flap fixation with fibrin sealant (ARTISS) tissue glue reduces seroma formation and seroma aspiration after mastectomy when compared with flap fixation using Vicryl sutures and when compared with a conventional wound closure technique.

METHODS

All patients undergoing mastectomy due to invasive breast cancer or ductal carcinoma in situ were eligible for inclusion. From May 2012 to March 2013, all patients undergoing mastectomy in 2 large breast cancer centers were treated using flap fixation with Vicryl sutures. From September 2013 to March 2014, all patients undergoing mastectomy were treated with flap fixation using ARTISS tissue glue. The data were retrospectively analyzed and compared with a "drain-only" group that was not treated with flap fixation (May 2011-March 2012).

RESULTS

A total of 230 women who underwent mastectomy were retrospectively analyzed in this trial; 88 patients were included in the drain-only group (DO), 92 patients were included in the flap fixation group using Vicryl sutures (FF-1), and 50 patients were included in the flap fixation group using ARTISS tissue glue (FF-2). There was significantly less seroma formation in the group after flap fixation using sutures (P = .006). There were significantly fewer patients who required seroma aspiration in the FF-1 group (P = .001) and the FF-2 group (P = .001) after undergoing mastectomy and sentinel node biopsy or modified radical mastectomy.

CONCLUSION

This study suggests that flap fixation after mastectomy using ARTISS tissue glue or sutures reduces postoperative seroma aspiration. As a result, flap fixation might lead to less patient discomfort. A randomized, prospective trial should be performed to verify these results.

摘要

背景

高达90%接受乳腺癌手术的患者会出现血清肿形成，这可能导致乳房切除术后不适及各种并发症。这项回顾性观察队列研究旨在阐明，与使用薇乔缝线进行皮瓣固定以及与传统伤口闭合技术相比，使用纤维蛋白封闭剂（ARTISS）组织胶水进行皮瓣固定是否能减少乳房切除术后血清肿的形成及血清肿抽吸。

方法

所有因浸润性乳腺癌或原位导管癌接受乳房切除术的患者均符合纳入标准。2012年5月至2013年3月，2家大型乳腺癌中心所有接受乳房切除术的患者均采用薇乔缝线进行皮瓣固定治疗。2013年9月至2014年3月，所有接受乳房切除术的患者均采用ARTISS组织胶水进行皮瓣固定治疗。对数据进行回顾性分析，并与未进行皮瓣固定的“仅置引流管”组（2011年5月至2012年3月）进行比较。

结果

本试验共对230例行乳房切除术的女性进行了回顾性分析；88例患者纳入仅置引流管组（DO），92例患者纳入使用薇乔缝线的皮瓣固定组（FF-1），50例患者纳入使用ARTISS组织胶水的皮瓣固定组（FF-2）。使用缝线进行皮瓣固定后的组中血清肿形成明显较少（P = .006）。在接受乳房切除术及前哨淋巴结活检或改良根治性乳房切除术后，FF-1组（P = .001）和FF-2组（P = .001）中需要进行血清肿抽吸的患者明显较少。