目的

探讨Mammotome 微创旋切术并发症的原因及防治措施。

方法

2009年6月至2011年5月在本院行Mammotome 手术患者共332 例,发生并发症者16 例,占4.8%, 对他们的资料进行分析。

结果

行Mammotome 手术的332 例患者中16 例发生并发症。并发症主要是术中或术后出血。术中出血50 ml 1 例、30 ml 3 例,皮肤破损1 例;术中及术后大出血约150 ml 1 例;术后双侧血肿2 例、单侧血肿3 例、副乳腺血肿1 例、出血量均在5 ～20 ml;皮下瘀血4 例。行Mammotome 手术的前100 例患者中7 例发生术中术后出血,皮肤破损1 例;随着经验的累积,后232 例患者中只有8 例发生术中术后出血。术中出血经压迫止血后顺利完成手术。术后血肿处理:反复抽吸加压包扎4 例,乳腺切开血肿清除1 例,长径＜2 cm 血肿、乳腺弥散的淤血及皮肤青紫均在1 个月后自行吸收。16 例患者随访1 个月～1年,愈合良好,无感染、乳房变形及病灶残留。

结论

术中、术后出血是Mammotome 手术的主要并发症。Mammotome 手术开展前期经验不足、术前准备不充分、术后压迫不到位、双侧多个病灶一次性切除是出血的主要原因。重视围手术期准备,熟练与超声医师配合,术后充分压迫及患侧制动,多发病灶分次手术,术中术后止血药的应用,分次抽吸出血,可有效防治并发症。

Objective

To analyze the complications of Mammotome operation and try to find out prevention and treatment methods.

Methods

From June 2009 to May 2011,a total of 332 patients received Mammotome operations in our hospital. Among them 16 patients had complications, accounting for 4.8%. The causes and treatment of the complications were analyzed .

Results

The main manifestation of the complications in the 16 cases was intrao- and post-operative hemorrhage. The intraoperative hemorrrhage volume was 50 ml in 1 case and 30 ml in 3 cases. Intraoperative skin damage was in 1 case. The intra- and post-operative hemorrhage volume was about 150 ml in 1 case. Bilateral postoperative hematoma was in 2 cases, unilateral hematoma in 3 cases, and accessory breast hematoma in 1 case, with hemorrhage volume 5-20 ml. Skin ecchymosis was in 4 cases.Among the first 100 cases with Mammotome operation, 7 cases had hemorrhage and 1 case had skin damage. With accumulation of experience, only 8 cases had complications among the 232 cases afterwards. For intraoperative hemorrhage, pressing for hemostasis was used to make the operation successfully completed. For postoperative hemorrhage, the management included repeated aspiration and pressure dressing in 4 cases, and cutting open of hematoma to clean the blood in 1 case; hematoma ＜2 cm, dispersed ecchymosi and skin cyanosis did not need any management, for they could be absorbed themselves one month after operation.The follow-up was 1 month to 1 year, showing that all the 16 cases healed well, and no breast deformity or tumor residual occured.

Conclusions

Intra- and post-operative bleeding are the main complications. The main reasons were lack of experience, inadequate preoperative preparation, ineffective post-operative compression, and removal of multiple lesions of both sides at one time. Sufficient perioperative preparation, good cooperation of surgeons with doctors from ultrasound departments, effective post-operative compression,reasonably fractionated removal of multiple lesions, postopertaive immobilization, usage of hemostatic drug, and fractionated aspiration of hemorrhage are effective prevention and treatment ways of Mammotome complications.