淋巴漏專題宣講

淋巴漏淋巴漏專題宣講第1頁(yè)淋巴漏定義乳腺癌術(shù)后3~4天，臨床表現(xiàn)為切口引流管內(nèi)每日約有200~500ml淡黃色淋巴液流出或拔除引流后管口、切口有大量液體滲出，經(jīng)久不愈，則可稱為淋巴漏。乳腺癌術(shù)后常見(jiàn)并發(fā)癥之一，其發(fā)病率高達(dá)12.2%。淋巴漏專題宣講第2頁(yè)術(shù)后淋巴瘺危害假如處理不妥，可造成患者血容量降低、電解質(zhì)紊亂、淋巴細(xì)胞下降及低蛋白血癥，引發(fā)繼發(fā)傷口感染，造成截肢甚至危及生命。給患者帶來(lái)了巨大思想負(fù)擔(dān)和經(jīng)濟(jì)負(fù)擔(dān)淋巴漏專題宣講第3頁(yè)淋巴液成份與組織液相同（含小分子蛋白和纖維蛋白原）淋巴漏專題宣講第4頁(yè)淋巴漏專題宣講第5頁(yè)淋巴瘺成因與預(yù)防形成條件：高壓量多破口上臂過(guò)分活動(dòng)低蛋白血癥腫瘤分期電刀過(guò)分使用

淋巴清掃范圍擴(kuò)大

預(yù)防術(shù)后注意休息充分術(shù)前準(zhǔn)備改進(jìn)手術(shù)操作淋巴漏專題宣講第6頁(yè)傳統(tǒng)治療抗生素引流法填塞法詳細(xì)方法為向切口內(nèi)塞入油紗條或碘伏紗條壓緊，4~6天后取出，使漏管充分受壓粘合。

營(yíng)養(yǎng)療法水，電解質(zhì)，高蛋白

手術(shù)淋巴漏專題宣講第7頁(yè)治療新進(jìn)展復(fù)方泛影葡胺注射液治療治療原理：復(fù)方泛影葡胺注射液臨床上主要用于各種造影檢驗(yàn)，是一個(gè)高滲性液體，可在局部快速形成高滲狀態(tài)，使組織脫水，收縮淋巴管，粘合組織，在局部產(chǎn)生粘連，使假腔內(nèi)淋巴液降低，到達(dá)阻塞淋巴管，治療淋巴瘺效果。治療優(yōu)點(diǎn)：不壓迫深部血管，不影響靜脈壓，可促進(jìn)肉芽組織生長(zhǎng)，加緊傷口愈合，可被組織吸收，不留異物。治療效果：方法簡(jiǎn)單，療效顯著，注射2次后淋巴液顯著降低，5次后可到達(dá)治愈目標(biāo)淋巴漏專題宣講第8頁(yè)

Lanreotideautogel90mgandlymphorrheapreventionafteraxillarynodedissectioninbreastcancer:AphaseIIIdoubleblind,randomized,placebo-controlledtrial.

AbstractAIM:TheaimofthisstudywastoassesstheefficacyofLanreotide（蘭瑞肽）Autogel90mgPRtopreventlymphorrheaafteraxillarydissectioninbreastcancer.METHODS:APhaseIIIdouble-blind,randomized,placebo-controlledtrialwasperformedbetweenApril1st,,andDecember31st,.Theprimaryendpointwasthelymphorrheavolume(ml)intheaxillarydrainduringthefirstfourpostoperativedays.Thesecondaryendpointswerethenumberofdaysuntilaxillarydrainremoval,hospitalstayduration(days),lymphorrheavolume(ml)uptodays15,30and180,numberofcaseswithseromaaspirationandnumberofseromaaspirations,evaluationofwound,armpainandmobilityondays15,30and180.RESULTS:Atotalof148patientswererecruitedforthestudy.Altogether145patientswererandomizedandanalysedonanintention-to-treatbasis.Onthedaybeforesurgery73patientsreceivedtheplaceboand72patientsreceivedlanreotide.Atfourpostoperativedays,therewasatendencytowardsareductionofthelymphorrheavolumeinthelanreotidegroup(median292ml,range1-965ml)ascomparedtotheplacebogroup(median337ml,range0-1230ml),althoughitwasnotstatisticallysignificant(p=0.18).Therewasnosignificantdifferenceforthesecondaryendpoints.Inthegroupwithaxillarydissectionperformedalone(n=24),thelymphorrheavolumewasshowntobesignificantlyreducedinthelanreotidegroup,(p=0.035)ascomparedtotheplacebogroup.CONCLUSION:Ourstudydidnotidentifyanyoverallsignificantreductionoflymphorrheaonlanreotide.

淋巴漏專題宣講第9頁(yè)SomatostatininbreastcancerAbstractInman,somatostatin（生長(zhǎng)抑素）isahormonemostlyproducedbyhypothalamus.Itplaysdifferentpartsinhormonalregulationthroughmanyspecificreceptorsinhumanbody.Ithasalsotwointerestingactionssuchasananti-secretoryactivity,mostlyonthegastrointestinalsystemandanantiproliferativeactionontumorcells.Manysyntheticsomatostatinanalogues,morestablethanthenaturalone,havebeendevelopedandarealreadyusedindigestivesurgerytotreatpostoperativedigestivefistula.Also,thedevelopmentofspecificpolyclonalantibodiesallowedtheidentificationoffivespecificsomatostatinreceptorsandtheirlocalizationindifferentcellspecies.Thepresenceofthefivereceptorsinbreastcancercellshasthanbeendemonstrated.Thepurposeofthisliteraturereviewistoclarifythepotentialantitumoreffectofsomatastatinanaloguesinbreastcancer;itsuseasapreventiveagentonlymphorrheaafterbreastsurgeryanditsemploymentinimagingforearlybreastcancerdetection.

淋巴漏專題宣講第10頁(yè)Effectofcollagenpowderonlymphorrheaaftermodifiedradicalmastectomy.Arandomizedcontrolledtrial.AbstractPostoperativelymphorrheaisamajorcomplicationofaxillarylymphadenectomy.TheaimofourstudywastoevaluatetheimpactoftypeIcollageninpostoperativelymphorrheainmastectomypatients.Eightypatientsthatunderwentmodifiedradicalmastectomyforbreastcancerwererandomizedintwogroups.IngroupA(collagengroup,n=42)collagentypeI(CellerateRXpowder)wasappliedintheaxillarycavityafterlymphadenectomywhileingroupB(controlgroup,n=38)lymphadenectomywasperformedinthestandardfashionwithouttheuseofasealant.Suctiondrainsremainedinplaceuntilthedailyamountoflymphaticdrainagefellunder30ml.Thetotalamountandthedurationofdrainage,aswellasthemorbidityandseverityofarmpainwerecomparedinthetwogroups.Therewasanonsignificanttrendtowardsloweroveralldrainageinthecollagengroup.Thedurationofdrainageandpostoperativepainweresimilarinthetwogroups,aswasmorbidity.Subgroupanalysisofpatientsaccordingtothenumberoflymphnodesexcised,revealedsignificantlylesslymphorrheaintermsofvolumeanddurationinpatientswhohadmorethantenlymphnodesexcised.Collagen（膠原）typeI(CellerateRXpowder)appearstoattenuatepostoperativelymphorrheainpatientsundergoingaxillarylymphadenectomyespeciallywhen>10lymphnodesareremoved.淋巴漏專題宣講第11頁(yè)AxillaryPaddingwithoutDrainageafterAxillaryLymphadenectomy–aProspectiveStudyof299PatientswithEarlyBreastCancerSummaryBackground:Afterlymphadenectomyforearlybreastcancer,seromaformationisaconstanteventrequiringasuctiondrainage.Thisdrainageisthestrongestobstacletoreducingthehospitalstay.Axillarypaddingwithoutdrainageappearstobeavaluableoptionamidthevarioussolutionsforreducingthehospitalstay.Methods:Weconductedacomparisonbetween114patientswithpaddingand185patientswithdrainage.Datawereobtainedfrom2successiveprospectivestudies.Results:Themeanhospitalstaywas2.4days(range1–4)inthepaddinggroupand4.2days(range2–9)inthedrainagegroup(p<0.05).Therewerefewerneedleaspirationsforseromainthepaddinggroup(8.8vs.23%,p<0.05).At6weeks,only28%(32/114)ofthepatientsinthepaddinggroupreportedpainversus51%(94/185)inthedrainagegroup.Themeanpainintensityat6w