淋巴漏專題宣講

淋巴漏淋巴漏專題宣講第1頁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)后常見并發(fā)癥之一，其發(fā)病率高達12.2%。淋巴漏專題宣講第2頁術(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。給患者帶來了巨大思想負擔和經(jīng)濟負擔淋巴漏專題宣講第3頁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頁淋巴漏專題宣講第5頁淋巴瘺成因與預防形成條件：高壓量多破口上臂過分活動低蛋白血癥腫瘤分期電刀過分使用

淋巴清掃范圍擴大

預防術(shù)后注意休息充分術(shù)前準備改進手術(shù)操作淋巴漏專題宣講第6頁傳統(tǒng)治療抗生素引流法填塞法詳細方法為向切口內(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頁治療新進展復方泛影葡胺注射液治療治療原理：復方泛影葡胺注射液臨床上主要用于各種造影檢驗，是一個高滲性液體，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，到達阻塞淋巴管，治療淋巴瘺效果。治療優(yōu)點：不壓迫深部血管，不影響靜脈壓，可促進肉芽組織生長，加緊傷口愈合，可被組織吸收，不留異物。治療效果：方法簡單，療效顯著，注射2次后淋巴液顯著降低，5次后可到達治愈目標淋巴漏專題宣講第8頁

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SomatostatininbreastcancerAbstractInman,somatostatin（生長抑素）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