对接受保乳治疗的患者不进行腋窝引流的腋窝淋巴结清扫术的评估。
Evaluation of axillary lymphadenectomy without axillary drainage for patients undergoing breast-conserving therapy.
作者信息
Zavotsky J, Jones R C, Brennan M B, Giuliano A E
机构信息
The Joyce Eisenberg Keefer Breast Center of the John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California 90404, USA.
出版信息
Ann Surg Oncol. 1998 Apr-May;5(3):227-31. doi: 10.1007/BF02303777.
BACKGROUND
The routine use of drainage after axillary node dissection in patients undergoing breast-conserving therapy (BCT) is being questioned. To determine the value of routine drainage, we evaluated the postoperative course of patients with primary breast carcinoma who underwent axillary dissection with or without axillary drainage.
METHODS
A retrospective review of 69 patients prompted a prospective randomized trial of 46 patients undergoing BCT at our tertiary cancer center. Variables studied were age, treatment (drain or no drain), number and tumor status of excised lymph nodes, size of primary tumor, duration of drainage or aspiration, number and volume of aspirations, number of office visits, incidence of complications and degree of pain, change in arm or forearm circumference, and body mass index (BMI). Data from prospective and retrospective studies were pooled for analysis.
RESULTS
Of 115 patients, 72 were treated with a drain (Drain group) and 43 were not (No-drain group). Overall there was no difference in the number or tumor status of excised nodes, the size of the primary tumor, or the incidence of complications between the two groups. Aspiration was required in 50% of the No-drain patients and 8.3% of the Drain patients. The incidence of drain placement or replacement postoperatively was 9.3% for the No-drain patients and 4.2% for the Drain patients. The No-drain patients had more office visits (5.1 +/- 0.4 vs. 3.6 +/- 0.1; P = .0002) and a longer interval between operation and last aspiration or drain removal (16.2 +/- 1.4 days vs. 11.3 +/- 0.6 days; P = .0040). Findings were similar in the subgroup of 46 prospectively studied patients, who included 24 Drain patients and 22 No-drain patients. In this group, pain evaluation using a scale of 0 to 10 showed a mean rating of 4.2 +/- 2.6 in Drain patients and 2.7 +/- 0.4 in No-drain patients (P = .0062).
CONCLUSIONS
Axillary node dissection can be managed with or without a drain. More office visits but less pain can be expected if a drain is not used.
背景
保乳治疗（BCT）患者腋窝淋巴结清扫术后常规使用引流管正受到质疑。为确定常规引流的价值，我们评估了接受腋窝清扫且有或无腋窝引流的原发性乳腺癌患者的术后病程。
方法
对69例患者的回顾性研究促使我们在三级癌症中心对46例行BCT的患者进行前瞻性随机试验。研究的变量包括年龄、治疗方式（引流或不引流）、切除淋巴结的数量和肿瘤状态、原发肿瘤大小、引流或抽吸的持续时间、抽吸的次数和量、门诊就诊次数、并发症发生率和疼痛程度、手臂或前臂周长的变化以及体重指数（BMI）。将前瞻性和回顾性研究的数据汇总进行分析。
结果
115例患者中，72例接受引流治疗（引流组），43例未接受引流治疗（无引流组）。总体而言，两组之间切除淋巴结的数量或肿瘤状态、原发肿瘤大小或并发症发生率没有差异。无引流组50%的患者需要抽吸，引流组为8.3%。无引流组患者术后引流管放置或更换的发生率为9.3%，引流组为4.2%。无引流组患者的门诊就诊次数更多（5.1±0.4次对3.6±0.1次；P = .0002），手术与最后一次抽吸或拔除引流管之间的间隔时间更长（16.2±1.4天对11.3±0.6天；P = .0040）。在46例前瞻性研究患者的亚组中，结果相似，该亚组包括24例引流患者和22例无引流患者。在该组中，使用0至10分的疼痛评估量表显示，引流组患者的平均评分为4.2±2.6分，无引流组为2.7±0.4分（P = .0062）。
结论
腋窝淋巴结清扫术可在有或无引流管的情况下进行。如果不使用引流管，预计门诊就诊次数会更多，但疼痛会减轻。
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