Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, University of Rome Tor Vergata, Rome, Italy.
Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy.
Anticancer Res. 2023 May;43(5):2135-2143. doi: 10.21873/anticanres.16375.
BACKGROUND/AIM: Among postoperative complications in breast surgery, postoperative hematoma is the most common occurrence. While mostly self-limited, in some cases surgical revision is mandatory. Among percutaneous procedures, preliminary studies demonstrated the efficacy of vacuum-assisted breast biopsy (VAB) in evacuating postprocedural breast hematomas. However, no data are available regarding VAB evacuating postoperative breast hematomas. Therefore, the present study aimed to investigate the efficacy of the VAB system in evacuating postoperative and postprocedural hematoma, symptom resolution, and avoidance of surgery.
From January 2016 to January 2020, patients with ≥25 mm symptomatic breast hematomas developed after breast-conserving surgery (BCS) and percutaneous procedures were retrospectively enrolled from a perspective-maintained database. Hematoma maximum diameter, estimated hematoma volume, total procedure time, and visual analog scale (VAS) score before ultrasound (US) vacuum-assisted evacuation (VAEv) were recorded. At one-week VAS score, residual hematoma volume, and complications were recorded.
Among 932 BCSs and 618 VAB procedures, a total of 15 late postoperative hematomas were recorded (9 after BCS and 6 after VAB). Preoperative median diameter was 43.00 (35.50-52.50) mm and median volume 12.60 (7.35-18.30) mm Regarding VAEv, median time recorded was 25.92 (21.89-36.81) min. At one week, the median hematoma reduction was 83.00% (78.00%-87.5%) with a statistically significant VAS reduction (5.00 vs. 2.00; p>0.001). No surgical treatment was needed and only one case of seroma occurred.
VAEv represents a promising safe, time and resource-sparing treatment modality for the evacuation of breast hematomas, potentially decreasing the rate of reoperation after surgery.
背景/目的：在乳房手术后的并发症中，术后血肿是最常见的情况。虽然大多是自限性的，但在某些情况下需要进行手术修正。在经皮操作中，初步研究表明真空辅助乳房活检（VAB）在排空术后乳房血肿方面具有疗效。然而，目前还没有关于 VAB 排空术后乳房血肿的数据。因此，本研究旨在探讨 VAB 系统在排空术后和经皮操作后血肿、症状缓解和避免手术方面的疗效。
从 2016 年 1 月至 2020 年 1 月，从一个维护的数据库中回顾性纳入了接受保乳手术（BCS）和经皮操作后出现≥25mm 症状性乳房血肿的患者。记录血肿最大直径、估计血肿体积、总操作时间和超声（US）真空辅助排空（VAEv）前的视觉模拟评分（VAS）。在一周时的 VAS 评分、残余血肿体积和并发症。
在 932 例 BCS 和 618 例 VAB 操作中，共记录了 15 例晚期术后血肿（9 例发生在 BCS 后，6 例发生在 VAB 后）。术前中位直径为 43.00（35.50-52.50）mm，中位体积为 12.60（7.35-18.30）mm。关于 VAEv，记录的中位时间为 25.92（21.89-36.81）min。在一周时，血肿减少中位数为 83.00%（78.00%-87.5%），VAS 明显降低（5.00 与 2.00；p>0.001）。不需要手术治疗，只有 1 例发生血清肿。
VAEv 是一种有前途的安全、省时、节省资源的治疗方法，可减少术后再次手术的发生率。
