Samal Shubham, Ramchandani Radhakrishna, Mohanty Debajyoti
General Surgery, All India Institute of Medical Sciences, Raipur, Raipur, IND.
Cureus. 2024 Jun 13;16(6):e62320. doi: 10.7759/cureus.62320. eCollection 2024 Jun.
Breast cancer is one of the most common malignancies in women. Hence, its treatment has become our utmost priority in developing countries like India. Modified radical mastectomy (MRM) has traditionally been used as the standard of care for early-stage invasive breast carcinoma and still is the most commonly used surgical treatment for carcinoma breast.
The study compared the incidence of intraoperative and postoperative outcomes with skin flaps raised using a harmonic scalpel versus those raised using electrocautery.
Sixty women with biopsy-proven breast cancer who had to undergo MRM were randomly assigned to undergo skin flap raising during mastectomy by using electrocautery or harmonic scalpel. Thirty patients had surgery with electrocautery (Group 1) and 30 with a harmonic scalpel (Group 2) by the same surgical team.
The mean operative time was significantly longer with harmonic scalpel when compared to that with electrocautery (140.67 ± 28.55 vs. 122.00 ± 19.16 mins, P =0.004). The amount of intraoperative blood loss (178.33 ± 21.06 vs 138.50 ± 28.53 mL P = 0.001) was less in the group operated with the harmonic scalpel, which was statistically significant. There was no significant difference between the groups regarding total drainage content (310.83 ± 88.93 vs 298.20 ± 127.87 mL, P = 0.659), drain duration (6.83 ± 0.75 vs 7.43 ± 2.27 days, p=0.174), seroma (3.3% vs. 0%) wound infection (3.3% vs 0%), flap necrosis (16.7% vs. 3.3%, P = 0.195), duration of hospital stays (8.57 ± 0.77 vs 8.43 ± 1.61 days, p=0.684).
Harmonic scalpels have a few advantages over electrocautery, but are not cost-effective.
乳腺癌是女性最常见的恶性肿瘤之一。因此，在印度等发展中国家，其治疗已成为我们的首要任务。改良根治性乳房切除术（MRM）传统上一直被用作早期浸润性乳腺癌的标准治疗方法，并且仍然是乳腺癌最常用的手术治疗方法。
本研究比较了使用谐波手术刀与使用电灼器掀起皮瓣时术中及术后结果的发生率。
60例经活检证实患有乳腺癌且必须接受MRM的女性被随机分配在乳房切除术中使用电灼器或谐波手术刀掀起皮瓣。30例患者由同一手术团队进行电灼手术（第1组），30例使用谐波手术刀手术（第2组）。
与电灼器相比，使用谐波手术刀时平均手术时间明显更长（140.67±28.55对122.00±19.16分钟，P = 0.004）。使用谐波手术刀手术的组术中失血量较少（178.33±21.06对138.50±28.53 mL，P = 0.001），具有统计学意义。两组在总引流量（310.83±88.93对298.20±127.87 mL，P = 0.659）、引流持续时间（6.83±0.75对7.43±2.27天，p = 0.174）、血清肿（3.3%对0%）、伤口感染（3.3%对0%）、皮瓣坏死（16.7%对3.3%，P = 0.195）、住院时间（8.57±0.77对8.43±1.61天，p = 0.684）方面无显著差异。
谐波手术刀比电灼器有一些优势，但不具有成本效益。
