Tokiyoshi Takahiro, Tsunashima Chiharu, Nomura Tadashi, Hashikawa Kazunobu, Terashi Hiroto, Kawamura Susumu
Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
Department of Plastic and Reconstructive Surgery, Independent Administrative Agency National Hospital Organization Shikoku Cancer Center, Matsuyama, Ehime, Japan.
Kobe J Med Sci. 2020 Feb 28;65(4):E132-E137.
Prolonged drain placement occasionally causes complications such as infection in patients who have undergone implant-based breast reconstruction; therefore, the drainage period must be shortened to avoid complications.
To identify the factors that prevent prolonged drain placement in patients who have undergone immediate breast reconstruction with tissue expanders.
This was a retrospective medical chart review of all patients who underwent immediate breast reconstruction with tissue expanders at a single center from April 2013 to March 2016. Closed-suction drains were placed in and on the implant pocket. An extra drain was positioned in the axilla in patients undergoing axillary lymph node dissection. The drains were removed at a drainage volume of ≤50 ml per 24 hours. Prolonged drain placement was defined as a period greater than the 75th percentile among all patients. Nine potential risk factors associated with prolonged drain placement were analyzed with multivariate logistic regression analysis.
In total, 89 tissue expanders in 89 patients were placed in this study. Prolonged drain placement, determined as ≥9 days (range, 5-14 days), was significantly associated with body mass index ≥25 kg/m2, tissue expander size ≥500 ml, and intraoperative bleeding ≥100 ml, in the multivariate analysis. Axillary lymph node dissection with extra-axillary drainage did not prolong the drainage period.
Our findings suggested that placing an extra-axillary closed-suction drain following axillary dissection, and reducing intraoperative bleeding and surgical trauma, could prevent prolonged drain placement in immediate breast reconstruction with tissue expanders.
在接受植入式乳房重建的患者中，长时间放置引流管偶尔会引发感染等并发症；因此，必须缩短引流时间以避免并发症。
确定在接受组织扩张器即刻乳房重建的患者中，防止引流管放置时间过长的因素。
这是一项对2013年4月至2016年3月在单一中心接受组织扩张器即刻乳房重建的所有患者进行的回顾性病历审查。在植入腔隙内及周围放置闭式吸引引流管。接受腋窝淋巴结清扫的患者在腋窝额外放置一根引流管。当24小时引流量≤50 ml时拔除引流管。引流管放置时间过长定义为超过所有患者第75百分位数的时间段。采用多因素逻辑回归分析对与引流管放置时间过长相关的9个潜在风险因素进行分析。
本研究共为89例患者植入了89个组织扩张器。在多因素分析中，引流管放置时间过长（定义为≥9天，范围为5 - 14天）与体重指数≥25 kg/m²、组织扩张器大小≥500 ml以及术中出血≥100 ml显著相关。腋窝淋巴结清扫并进行腋窝外引流并未延长引流时间。
我们的研究结果表明，腋窝清扫后放置腋窝外闭式吸引引流管，以及减少术中出血和手术创伤，可以防止在组织扩张器即刻乳房重建中引流管放置时间过长。
