Tamminen Anselm, Huttunen Tuomas, Meretoja Tuomo, Niinikoski Laura, Koskivuo Ilkka
Department of Plastic and General Surgery, Turku University Hospital and University of Turku, Turku, Finland.
Department of Breast Surgery, Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Eur J Surg Oncol. 2023 Jan;49(1):68-75. doi: 10.1016/j.ejso.2022.08.030. Epub 2022 Aug 31.
The aim of this study was to evaluate the rate of postoperative bleeding complications (primary outcome) and any other surgical complications (secondary outcome) in mastectomy between two surgical instruments, ultrasonic SonoSurg® scissors (US) and traditional electrocautery (EC).
In total 728 patients undergoing mastectomy in two adjacent university hospitals were retrospectively evaluated in terms of postoperative bleeding episodes, surgical site infections, skin flap necrosis, and any reoperations for 30 postoperative days. A propensity score matching was performed to acquire balanced groups. Patients consuming medications affecting hemostasis were excluded from the study. A multivariable logistic regression analysis was conducted to define the odds ratio (OR) for each complication separately. A cost analysis was performed.
The rate of postoperative bleeding complications was significantly lower in patients operated with US (0.3% vs 11.5%, OR 0.020, 95% CI 0.034-0.14) when compared to EC. The rate of surgical site infections (OR 0.65, 95% CI 0.35-1.23) was similar with both instruments, but there were less skin flap necroses (OR 0.35, 95% CI 0.13-0.98) in US group. For any reoperation, the OR for US was 0.13 (95% CI 0.046-0.39), mainly due to the lower number of acute bleeding complications. Even though the US instrument is more expensive than EC, the total cost of the treatment is lower in patients operated with US (3419 vs. 3475 euro).
US seems to be associated with a lower risk of bleeding complications in mastectomy.
本研究旨在评估两种手术器械，即超声SonoSurg®剪刀（US）和传统电灼术（EC）在乳房切除术中术后出血并发症发生率（主要结局）及任何其他手术并发症（次要结局）。
对两家相邻大学医院共728例行乳房切除术的患者进行回顾性评估，观察术后30天内的出血事件、手术部位感染、皮瓣坏死及任何再次手术情况。进行倾向评分匹配以获得均衡组。服用影响止血药物的患者被排除在研究之外。分别进行多变量逻辑回归分析以确定每种并发症的比值比（OR）。进行了成本分析。
与EC相比，使用US进行手术的患者术后出血并发症发生率显著更低（0.3%对11.5%，OR 0.020，95%CI 0.034 - 0.14）。两种器械的手术部位感染发生率相似（OR 0.65，95%CI 0.35 - 1.23），但US组的皮瓣坏死较少（OR 0.35，95%CI 0.13 - 0.98）。对于任何再次手术，US的OR为0.13（95%CI 0.046 - 0.39），主要是由于急性出血并发症数量较少。尽管US器械比EC更昂贵，但使用US进行手术的患者治疗总成本更低（3419对3475欧元）。
在乳房切除术中，US似乎与较低的出血并发症风险相关。
