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目的分析乳腺癌术后皮瓣坏死的原因及探讨防治措施。方法对64例乳腺癌患者术后的临床资料进行总结,回顾性分析手术方式、切口选择、皮瓣厚度、皮瓣张力、单管或双管引流与皮瓣坏死程度的关系。结果 64例乳腺癌患者中,术后皮瓣坏死12例,占18.75%。皮瓣坏死与切口选择、皮瓣厚度和皮瓣张力单或双管引流有关(P<0.05)。采用横形切口11.63%(5/43)、厚皮瓣10.26%(4/39)、低张力皮瓣8.33%(3/36)、双管引流5.00%(1/20)者的皮瓣坏死发生率分别较纵梭形切口(33.33%,7/21)、薄皮瓣(32.00%,8/25)和高张力皮瓣(32.14%,9/28)、单管引流(25.00%,11/44)者低,差异有统计学意义(P<0.05)。结论乳腺癌术后皮瓣坏死原因是多方面的,皮瓣供血不足是术后皮瓣坏死的根本原因。合理的选择手术切口,选择适当厚度的皮瓣,无张力缝合,保护皮瓣血运,术后双管引流等是防治皮瓣坏死的关键措施。
Objective To analyze the causes of postoperative flap necrosis of breast cancer and to explore the preventive measures. Methods The clinical data of 64 patients with breast cancer were retrospectively analyzed. The surgical methods, incision selection, flap thickness, flap tension, and the relationship between single or double tube drainage and the degree of necrosis of the flap were retrospectively analyzed. Results 64 cases of breast cancer patients, postoperative flap necrosis in 12 cases, accounting for 18.75%. Flap necrosis was related to incision selection, flap thickness and single or double-tube drainage of flap tension (P <0.05). The skin flap necrosis occurred in 11.63% (5/43) transverse incision, 10.26% (4/39) in thick flap, 8.33% (3/36) in low tension flap and 5.00% (1/20) in double-tube drainage (33.33%, 7/21), thin flap (32.00%, 8/25), high tension flap (32.14%, 9/28) and single tube drainage (25.00%, 11 / 44) were lower, the difference was statistically significant (P <0.05). Conclusion There are many causes of skin flap necrosis after breast cancer surgery. The shortage of flap blood supply is the fundamental cause of skin flap necrosis. Reasonable choice of surgical incision, the choice of the appropriate thickness of the flap, tension-free suture to protect the blood supply of the flap, double drainage after surgery and other key measures to prevent skin flap necrosis.