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目的总结便携式负压引流系统在乳腺癌改良根治术应用中存在的问题,并提出解决方案。方法对2013年1月至9月在我院行乳腺癌改良根治术后使用便携式负压引流系统的268例患者的病例资料进行回顾性分析,根据是否使用普通负压球分为双腔组与单腔组两组。统计两组穿刺部位出血的发生率、术后引流量、置管时间及住院时间。结果两组共出现穿刺部位出血23例,其中22例为早期出血,1例为延迟出血。双腔组中胸骨旁引流管置管时间(中位数5.0d)明显少于腋窝引流管(中位数为9.0d;Z=-10.713,P=0.000)。双腔组(以腋窝引流管拔管为准)与单腔组术后置管时间(中位数分别为9.0d和10.0d)、术后住院时间(中位数均为9.0d)差异均无统计学意义。本研究中97.8%(262/268)患者选择带管出院,但出院指导资料缺乏。结论便携式负压引流系统存在穿刺部位出血、无法实现独立计量和独立拔管、出院指导不足等缺点,建议改进穿刺器,采用双腔双管独立引流,增加出院指导资料,使得该引流系统更加完善。
Objective To summarize the problems existing in the application of portable negative pressure drainage system in the modified radical mastectomy of breast cancer and propose the solution. Methods A retrospective analysis was performed on 268 cases of patients with portable negative pressure drainage system after modified radical mastectomy in our hospital from January to September 2013. According to whether the common negative pressure ball was used, Single chamber group two groups. The incidences of bleeding, the amount of drainage, the time of catheterization and the length of stay in the two groups were calculated. Results There were 23 cases of puncture site bleeding in both groups, of which 22 cases were early bleeding and 1 case was delayed bleeding. The time for catheterization of the parasternal drainage tube in the dual-lumen group (median 5.0 d) was significantly less than that in the axillary drainage tube (median 9.0 d; Z = -10.713, P = 0.000). The difference in mean duration of postoperative hospital stay (both median 9.0d) was significantly different between the dual-lumen group (armpit drainage tube extubation) and the single-lumen group (median 9.0d and 10.0d, respectively) No statistical significance. In this study, 97.8% (262/268) of the patients were discharged with a tube, but lacking of discharge guidance data. Conclusions The portable negative pressure drainage system has some defects such as hemorrhage in the puncture site, independent measurement and independent extubation, lack of discharge guidance and so on. It is suggested to improve the puncture device and to use double-lumen double-tube independent drainage to increase the discharge guidance data to make the drainage system more perfect .