封闭式负压吸引技术预防腹股沟淋巴结清扫术后淋巴漏
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摘要
目的探讨封闭式负压吸引技术预防腹股沟淋巴结清扫术后淋巴漏的临床疗效。方法自2016年3月至2018年3月对15例下肢恶性肿瘤患者行原发病灶扩大切除术及腹股沟淋巴结标准清扫术,并同时将缝匠肌离断后覆盖股鞘固定于腹股沟韧带处;创面内放置负压引流球,外部给予持续负压吸引治疗7～9 d;对淋巴结清扫区行环形包扎;密切监测术区引流及下肢肿胀情况;术后14 d拆线。结果本组共15例患者,术后切口均一期愈合。随访6～24个月,局部未出现淋巴漏及水肿等并发症,疗效较满意。结论对于下肢恶性肿瘤需行腹股沟淋巴结清扫的患者应用封闭式负压吸引治疗,可以有效防止淋巴漏的发生;其操作简便易行,疗效确切,值得临床推广应用。
引文
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[2]丁小兵.进展期胃癌术后淋巴漏的诊断与防治分析[J].广西医学, 2017,39(11):1740-1741.
[3]徐王彦,崔伟伟,龚宝牛.乳腺癌术后腋窝淋巴漏的预防及治疗体会[J].临床医药文献电子杂志, 2017,4(8):1387,1390.
[4] SPIESS P E, DHILLON J, BAUMGARTEN A S, et al. Pathophysiological basis of human papillomavirus in penile cancer:key to prevention and delivery of more effective therapies[J]. CA Cancer J Clin, 2016,66(6):481-495.
[5] COIT D G, THOMPSON J A, ALGAZI A, et al. NCCN guidelines insights:melanoma, version 3.2016[J]. J Natl Compr Canc Netw,2016,14(8):945-958.
[6] STRATIGOS A, GARBE C, LEBBE C, et al. Diagnosis and treatment of invasive squamous cell carcinoma of the skin:european consensus-based interdisciplinary guideline[J]. Eur J Cancer,2015,51(14):1989-2007.
[7]鲍正清,方冬,纪永鹏,等.阴茎癌腹股沟淋巴结清扫腹腔镜手术的新进展[J].现代泌尿外科杂志, 2018,23(4):309-312,316.
[8] BALL M W, SCHWEN Z R, KO J S, et al. Lymph node density predicts recurrence and death after inguinal lymph node dissection for penile cancer[J]. Investig Clin Urol, 2017,58(1):20-26.
[9]朱耀,叶定伟,姚旭东,等.老年患者行腹股沟淋巴结清扫手术的并发症及防治对策[J].现代泌尿外科杂志, 2011,16(2):117-119.
[10]郭思恩,覃晓.腹股沟部血管手术后淋巴漏的诊断和治疗(附45例报告)[J].广西医科大学学报, 2010,27(6):940-941.
[11]楼文晖,刘颖斌,梁廷波,等.胰腺术后外科常见并发症诊治及预防的专家共识(2017)[J].协和医学杂志, 2017,8(2):139-146.
[12]陈萍,史举彤,杨牟. Patent Blue V示踪早期诊断、预防腹股沟区切口淋巴瘘的临床研究[D].青岛:青岛大学, 2007.
[13]陈铁,蒋松琪,江晓晖,等.腹股沟淋巴结清扫术后淋巴漏合并皮瓣坏死的处理[J].肿瘤基础与临床, 2013,26(6):546-547.
[14]贺聚良,莫昊,袁振超.腹股沟淋巴结清扫术后淋巴漏的预防及治疗进展[J].广西医科大学学报, 2017,34(11):1668-1670.
[15]陈炜,鲁葆春,王坚.胰腺术后乳糜瘘的处理[J].肝胆胰外科杂志, 2017,29(3):237-240.
[16] JФRGENSEN M G, TOYSERKANI N M, HYLDIG N, et al. Prevention of seroma following inguinal lymph node dissection with prophylactic, incisional, negative-pressure wound therapy(SEROMA trial):study protocol for a randomized controlled trial[J]. Trials, 2018,19(1):441.