Abstract：
Excess and prolonged axillary drainage is a frequent nuisance following axillary lymph node dissection (ALND) in breast cancer patients. No consensus exists about the best method to prevent this consistently and reliably. Tranexamic acid (TA) has been found to reduce the amount and duration of drainage, but the reduction is not optimal. We hypothesized that systemic administration of TA along with the topical application of hemocoagulase (H) to the axillary dissection bed may decrease the cumulative axillary drain output and shorten the requirement of drainage after ALND as compared to placebo.
Seventy women undergoing ALND for breast carcinoma were randomized into two groups, the intervention (TA + H) group and the control (C) group. The cumulative drain output (primary objective), duration of drainage, incidence of seroma formation after drain removal, number of seroma aspirations required, volume of seroma aspirated, and incidence of surgical site infection (SSI) were compared.
The mean cumulative output in the TA + H group was significantly lower than the C group (290 ± 200 mL vs. 552 ± 369 mL, p < 0.001). Axillary drains were removed significantly earlier in the TA + H group (6.6 ± 2.2 vs. 11.7 ± 6.0 days, p < 0.001), but the incidence of seroma formation (p = 0.34), number of aspirations required (p = 0.33), volume of seroma aspirated (p = 0.47), and the incidence of SSI (p = 0.07) were similar.
Perioperative systemic administration of tranexamic acid along with topical application of H to the axillary dissection bed is effective in reducing cumulative axillary drain output after ALND. This strategy may also facilitate earlier removal of suction drains.
Seventy women undergoing ALND for breast carcinoma were randomized into two groups, the intervention (TA + H) group and the control (C) group. The cumulative drain output (primary objective), duration of drainage, incidence of seroma formation after drain removal, number of seroma aspirations required, volume of seroma aspirated, and incidence of surgical site infection (SSI) were compared.
The mean cumulative output in the TA + H group was significantly lower than the C group (290 ± 200 mL vs. 552 ± 369 mL, p < 0.001). Axillary drains were removed significantly earlier in the TA + H group (6.6 ± 2.2 vs. 11.7 ± 6.0 days, p < 0.001), but the incidence of seroma formation (p = 0.34), number of aspirations required (p = 0.33), volume of seroma aspirated (p = 0.47), and the incidence of SSI (p = 0.07) were similar.
Perioperative systemic administration of tranexamic acid along with topical application of H to the axillary dissection bed is effective in reducing cumulative axillary drain output after ALND. This strategy may also facilitate earlier removal of suction drains.
摘要：
背景：乳腺癌患者腋窝淋巴结清扫术（ALND）后，腋窝引流过多和延长是常见的麻烦。对于始终可靠地防止这种情况的最佳方法没有共识。已经发现氨甲环酸（TA）可以减少排水的数量和持续时间，但减少不是最佳的。我们假设，与安慰剂相比，全身给药TA以及将血凝酶（H）局部应用于腋窝夹层床可能会减少累积的腋窝引流量，并缩短ALND后的引流需求。
方法：将70例接受ALND治疗的乳腺癌患者随机分为两组，干预(TA+H)组和对照组(C)。累积排放输出（主要目标），排水持续时间,拔除排水管后血清肿形成的发生率，需要血清肿的数量，抽吸的血清肿体积，比较手术部位感染（SSI）的发生率。
结果：TA+H组的平均累积输出明显低于C组（290±200mLvs.552±369毫升，p<0.001)。在TA+H组中，腋窝引流明显较早（6.6±2.2vs.11.7±6.0天，p<0.001)，但血清肿形成的发生率(p=0.34)，所需的愿望数量(p=0.33)，抽吸的血清肿体积（p=0.47），与SSI的发生率相似(p=0.07)。
结论：围手术期全身给药氨甲环酸并局部应用于腋窝夹层床可有效减少ALND后的累积腋窝引流输出。该策略还可以促进吸入排放口的较早移除。
方法：将70例接受ALND治疗的乳腺癌患者随机分为两组，干预(TA+H)组和对照组(C)。累积排放输出（主要目标），排水持续时间,拔除排水管后血清肿形成的发生率，需要血清肿的数量，抽吸的血清肿体积，比较手术部位感染（SSI）的发生率。
结果：TA+H组的平均累积输出明显低于C组（290±200mLvs.552±369毫升，p<0.001)。在TA+H组中，腋窝引流明显较早（6.6±2.2vs.11.7±6.0天，p<0.001)，但血清肿形成的发生率(p=0.34)，所需的愿望数量(p=0.33)，抽吸的血清肿体积（p=0.47），与SSI的发生率相似(p=0.07)。
结论：围手术期全身给药氨甲环酸并局部应用于腋窝夹层床可有效减少ALND后的累积腋窝引流输出。该策略还可以促进吸入排放口的较早移除。
