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目的总结乳腺癌改良根治术后常见三大并发症皮瓣坏死、皮下积液、患侧上肢水肿发生原因与对策。方法回顾性分析268例手术细节与并发症的关系。结果保留完整皮瓣真皮下血管网、真皮内连续缝合切口、不加压包扎、早期肩关节制动者皮瓣坏死率低。采用穿刺留置F8或F10引流管负压壶引流的方法治疗较大的皮下积液疗程约7~10d。结论保留完整皮瓣真皮下血管网、真皮内连续缝合切口,不加压包扎、早期肩关节制动,及时应用活血化瘀药物可减少皮瓣坏死的发生。对于较大的皮下积液采用穿刺留置F8或F10引流管负压壶引流的方法优于传统的反复抽吸与加压包扎方法。
Objective To summarize the causes and countermeasures of skin necrosis, subcutaneous effusion and ipsilateral upper limb edema after the three major complications of modified radical mastectomy in breast cancer. Methods Retrospective analysis of 268 cases of surgical complications and complications. The results preserved intact flap subdermal vascular network, continuous suture incision in the dermis, no pressure banding, early shoulder brake flap necrosis rate is low. Adopting puncture indwelling F8 or F10 drainage tube negative pressure pot drainage method for treatment of large subcutaneous fluid about 7 ~ 10d. Conclusion The intact skin flap subdermal vascular network and continuous dermal suture incision were preserved. No pressure bandaging, early shoulder brachial arrest, and timely application of blood circulation and removing stasis drugs can reduce the incidence of skin flap necrosis. For larger subcutaneous fluid using puncture indwelling F8 or F10 drainage tube negative pressure pot drainage is superior to the traditional method of repeated suction and compression bandaging.