Clinical analysis of 63 cases of negative pressure drainage after radical mastectomy: What is the negative pressure of drainage after mastectomy?

From 2004 to 20 10, 63 patients underwent radical mastectomy, and the postoperative negative pressure suction drainage and wound healing achieved good results. Clinical analysis is as follows. Materials and Methods There were 63 patients in this group, including 665,438 0 years old females and 2 males, aged from 36 to 67 years old, with an average of 565,438 0 years old. They all underwent radical mastectomy. Halsted radical operation 16 cases, Patey operation 26 cases, Auchincloss operation 2 cases10 cases. Two cases underwent primary skin grafting. Of the 63 patients, 6 (9.5%) had local hydrops under the flap, and 3 (4.8%) had pneumatosis under the skin, without flap necrosis.

Drainage method: Before the wound was sutured in radical mastectomy, 65,438+0 drainage tubes were placed beside the sternum, and 65,438 L-shaped drainage tubes were placed in the axillary midline with No.24 T-shaped drainage tube, and 3-4 lateral holes were cut respectively. The top end of one end of the drainage tube is placed at the highest separation point of the subclavian flap and the lower part of the armpit respectively, and the drainage tube keeps 2 ~ 3 cm with the brachial plexus and axillary blood vessels. The other end of the drainage tube is poked out from the skin flap under the front and outside of the chest wall wound, and is externally connected with a gastrointestinal decompression device (disinfection) to maintain continuous negative pressure drainage. The average postoperative drainage time was 7 days.

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Radical mastectomy has a wide range of excision, a large wound and a large flap covering the wound after operation. Postoperative drainage is often needed, and there are many kinds of drainage materials, such as semi-hose and unilateral drainage tube, and various reports are different. Using No.24 T-shaped drainage tube to connect gastrointestinal decompression device (disinfection) has good drainage effect and many advantages. Due to the large surgical trauma and wide area of damaged tissue, there is more fluid exudation in the early stage of tissue repair. If the wound drainage is not smooth, there will be subcutaneous effusion, which will increase the dead space and hinder the angiogenesis of capillaries. Floating skin flap often appears necrosis, which delays the healing time. Therefore, the growth of wound skin flap after operation, that is, wound healing and complete negative pressure drainage after operation, is conducive to reducing skin flap leakage, forming new blood supply between skin flap and chest wall, and reducing skin flap necrosis. After radical mastectomy, wound dressing is different from other surgical operations. Negative pressure device drainage can not only eliminate the dead space between tissues, prevent exudation and hematoma, but also reduce tissue edema, which is beneficial to venous return and flap survival. Because of the large coverage area of skin flap in radical mastectomy, it is difficult for dressing to cover the wound skin evenly, which makes the dressing pressure of wound skin flap uneven and is not conducive to the growth of skin flap. At the same time, due to the large wound, it is difficult to grasp the tightness of the dressing. If the dressing is loose, it is easy to accumulate fluid under the skin, and if it is tight, it will cause obstacles to blood circulation. Negative pressure and low pressure drainage overcome these shortcomings.

In order to prevent subcutaneous hydrops, pneumatosis and infection under the flap, we should pay attention to the following points in long-term practice: ① Choose a rubber tube with good elasticity, such as a T-shaped tube (preferably latex tube). You can't use too soft a tube. The tube is too soft, and the cavity is easy to close when it collapses under negative pressure, so it can't play the role of drainage. ② Drainage tube advocates another puncture. The diameter of the puncture port should be consistent with that of the drainage tube, and the leather hole leading out of the hose should be stitched and fixed to prevent air leakage and slippage, and the hose under the gastrointestinal decompression (disinfection) device should be connected. ③ When suturing the surgical wound, apply imported 3-0 suture under the skin first, then suture the skin, and then perform suction on the operating table to observe whether the suture leaks. If there is air leakage, the needle should be added at the air leakage place, otherwise the skin flap can not be close to the wound surface and it is easy to accumulate fluid under the skin. ④ For the sunken wounds after operation, such as the anterior sternum and armpit, the exudate is easy to stay and form local effusion. Bilateral drainage should be adopted to place it in the corresponding position, so that the exudate can be thoroughly drained in time. ⑤ The drainage tube is usually placed for 7 days. Because of the continuous negative pressure drainage, the drainage fluid can be completely absorbed, and the flap can have a better and sufficient adhesion time with the chest wall. When extubating, negative pressure should be eliminated to prevent nerve and blood vessel from being damaged. At the same time, the skin at the place where the original tube is placed is pressed with gauze above it, and the subcutaneous liquefied substance remaining in the sinus is squeezed out. The second drainage tube was treated in the same way. Then cover the skin where the rubber tube was originally placed with a dressing and compress it for 1 ~ 2 days. ⑥ This negative pressure drainage method is simple and easy to operate, which can get out of bed early, promote blood circulation and promote wound healing as soon as possible. Tube, lowering blood pressure. Nifedipine controlled-release tablets have shown good "fighting power" in the treatment and application of hypertension since they were listed abroad. With the application of domestic nifedipine sustained-release tablets, the clinical utilization rate of this drug in China has further expanded. It is of great significance to evaluate and analyze the clinical effectiveness and safety of domestic and imported drugs for their safe clinical application.

The results showed that the total effective rates of domestic and imported nifedipine controlled release tablets were 95% and 96? 67%, and there was no significant difference in the total effective rate between the two groups (P > 0. 05). 05); In-group comparison, compared with the control group, the 24-hour, day and night average systolic blood pressure and diastolic blood pressure after 8 weeks of medication, and the systolic blood pressure and diastolic blood pressure at each time point after 8 weeks of medication decreased significantly, with statistical significance (P < 0. 05? 0 1); There is no significant difference in functional tests between placebo group and control group, but there are differences in monitoring indexes and effective rate between experimental group and control group. There were no major adverse reactions in both groups. Therefore, like imported nifedipine controlled-release tablets, domestic nifedipine controlled-release tablets are safe and effective in the treatment of hypertension, with few adverse reactions and good tolerance, and are satisfactory antihypertensive drugs for mild to moderate hypertension in clinical application.