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[摘要] 目的探讨加压反包扎法预防及治疗体表手术后淋巴漏的临床疗效。方法187例体表肿瘤手术后患者采用不同包扎方法,前100例行常规包扎,后87例行加压反包扎。结果术后主要并发症皮下积液(淋巴漏)发生25例,其中常规组21例,加压反包扎组4例,常规组淋巴漏愈合时间平均(20.6±2.2)d,加压反包扎组平均愈合时间(10.4±1.8)d,两组术后淋巴漏发生率及淋巴漏愈合时间均有显著差异。结论手术后采用局部加压反包扎法包扎,能减少主要并发症淋巴漏的发生,促进淋巴漏愈合,提高手术质量。
[关键词] 淋巴漏; 外科手术; 加压反包扎
[中图分类号] R733 [文献标识码] A [文章编号] 1673-9701(2009)33-135-02
Clinical Application of Anti-bandage Pressure to Prevention and Treat Lymphatic Leakage
CHEN Shouwan WANG He HE Xuedong
The Department of Burns and Plastic Surgery of the People"s Hospital of Jianyang City,Jianyang 641400,China
[Abstract] ObjectiveTo study the clinical curative effect of anti-bandage pressure on prevention and treating of lymphatic leakage after surface surgery. Methods187 cases of surface toumer patients after surgery were bandagedby different methods,100 cases dressed by routine,the other 87 cases dressed by with anti-compression bandaging. ResultsThe major complications of postoperative subcutaneous fluid(lymphatic leakage)occurred in 25 cases,of which 21 cases of the conventional group,4 cases of anti-dressing,the average healing time of lymphatic leakage in the conventional group was(20.6±2.2)days,and the anti-pressure group was(10.4±1.8)days,two groups of patients the incidence of lymphatic leakage and healing time of lymphatic leakage had significantly different. ConclusionUsing the local anti-bandage pressure bandage after the operation,can reduce the major complications of lymphatic leakage and promote healing of lymphatic leakage and improve the quality of surgery.
[Key words]Lymphatic leakage; Surgery; Anti-bandage pressure
我院自2005年9月至今共收治体表不同部位淋巴管瘤、乳腺癌、淋巴瘤及淋巴结转移癌、腹股沟肿瘤患者187例,均经手术治疗,术后局部采用不同包扎方法,取得了满意效果,现报道如下。
1 资料与方法
1.1 一般资料
本组187例患者,男67例,女120例;年龄最小的6个月,最大为71岁。最大病变范围20cm×25cm,最小为3cm×2cm。按部位分类:病变发生于颈部45例,占24.06%;腋窝61例,占32.62%;胸背腰腹部34例,占18.18%;四肢31例,占16.57%;腹股沟16例,占8.55%。按疾病种类分:其中乳腺癌行腋窝淋巴结清扫48例,颈、腋窝、腹股沟淋巴结原位及转移癌54例,淋巴结炎性变27例,淋巴管瘤58例。将所有病例按入院时间先后,前100例采用常规包扎(单纯包扎或绷带加压包扎),后87例采用加压反包扎,未严格按病种分类。
1.2 方法
手术方法均按一般操作常规进行切除,分别结扎或者电凝�血点,结扎病变周围可能存在的淋巴管。常规组采用单纯包扎或者绷带加压包扎,视情况上引流条或负压引流管(袋),观察和换药;加压反包扎组则是在术后,视情况放置或不放置引流管,然后在术创周围缝一圈长线进行加压反包扎(类似于中厚皮植皮时的反包扎方法)。打结时第2个结为活结,缝线不剪断以备换药时调整包扎压力。压力以基本能保证术区不�血为度。
2 结果
术后主要并发症皮下积液(淋巴漏)发生25例,总发生率13.36%(诊断淋巴漏的依据是术后3~5d引流管的引流液不减少或者减少后增加,且颜色从淡血性转变为黄色)。其中常规组21例,加压反包扎组4例。淋巴漏发生后愈合时间,常规组12~60d,平均20.6d,加压反包扎组7~14d,平均10.4d。另外常规组中出现6例引流管周围软组织感染,红肿热痛,加强抗感染和换药后愈合;加压反包扎组无此现象。加压反包扎组中有2例出现包扎处表皮起小水泡,经适当减轻包扎压力后未出现皮肤坏死,不影响伤口愈合时间,主要发生在最初试行的病例,随着经验积累,对张力的准确把握,发生机会减少。两组各项指标的结果见表1。加压反包扎组在这两个指标方面均明显小于常规组,采用t检验,差异具有统计学意义(P
