PDF(Pubmed)
Abstract：
Seroma formation is a common sequel following modified radical mastectomy (MRM), which hinders healing, may prolong hospital stay, and cause a delay in adjuvant treatment. Closed suction drains have been used to prevent formation of seroma; however, the use of a single drain in the axilla along with draining the mastectomy flaps and axilla separately remains a topic of debate. This prospective randomized dual-arm study was conducted in the Department of Endocrine Surgery. All female patients with carcinoma breast diagnosed on core tissue biopsy, undergoing modified radical mastectomy, upfront or post neoadjuvant systemic therapy were included. Patients were randomized into two groups. In the first group, a single drain was placed in the axilla whereas in the second group, a drain each was placed below the mastectomy flaps and the axilla. Patients\' particulars and the weight of the mass excised along with the operative details were documented. The volume of the drain was recorded daily. The flap drain was removed on postoperative day 5 and the axillary drain was removed when the drain volume was less than 30 mL/24 h for 2 consecutive days. The period of drain placement, volume of drainage, volume of seroma (if formed), and other complications (if any) were recorded. Patients in the single drain group had a significantly earlier drain removal time as compared to those with double drains (p = 0.01). The number of patients in whom seroma formation had occurred was more in the double drain group, but the difference was not significant. The average volume of aspirated seroma fluid was insignificantly more in the single drain group. The only other complication noticed was flap necrosis-in 5% patients of the double drain group. Total volume of drainage (p < 0.0001) and type of drain (p = 0.0208) were associated with higher rates of seroma formation, whereas BMI (p = 0.0516), weight of excised breast mass (p = 0.407), and age (p = 0.6379) were not associated with the rate of seroma formation. Outcomes in terms of drain volume or seroma formation were statistically indifferent between the two groups. Still, use of only a single axillary drain should be promoted, keeping in mind the earlier drain removal period, better patient compliance, and reduced hospital stay.
摘要：
血清瘤形成是改良根治术（MRM）后的常见后遗症，这阻碍了愈合，可能会延长住院时间，并导致辅助治疗的延迟。已使用封闭的抽吸排水管来防止血清肿的形成；但是，在腋下使用单个引流器以及分别引流乳房切除术皮瓣和腋下仍然是一个争论的话题。这项前瞻性随机双臂研究在内分泌外科进行。所有女性乳腺癌患者经核心组织活检确诊，接受改良根治术,纳入了新辅助前或后系统治疗.将患者随机分为两组。在第一组中,在腋下放置了一个排水沟，而在第二组中，在乳房切除术皮瓣和腋窝下方分别放置一个引流管。记录患者的详细信息和切除的肿块的重量以及手术细节。每天记录排水管的体积。术后第5天取出皮瓣引流，连续2天引流量小于30mL/24h时取出腋窝引流。排水沟放置的时期，排水量,血清肿体积（如果形成），并记录其他并发症（如有）。与双排水沟组相比，单排水沟组的排水沟清除时间明显较早（p=0.01）。双重引流组出现血清肿形成的患者数量较多，但差异不显著。在单引流组中，抽吸的血清肿液体的平均体积没有显着增加。唯一发现的其他并发症是皮瓣坏死-双重引流组的5％患者。引流的总体积（p<0.0001）和引流类型（p=0.0208）与较高的血清肿形成率相关。而BMI(p=0.0516)，切除的乳房肿块的重量（p=0.407），年龄（p=0.6379）与血清肿形成率无关。两组之间在引流量或血清肿形成方面的结果在统计学上无差别。尽管如此，应推广仅使用单个腋窝引流管，记住较早的排水清除期，更好的患者依从性，减少住院时间。
