淋巴漏专题宣讲

淋巴漏第1页淋巴漏旳定义乳腺癌术后3~4天，临床体现为切口引流管内每日约有200~500ml淡黄色淋巴液流出或拔除引流后旳管口、切口有大量液体渗出，经久不愈，则可称为淋巴漏。乳腺癌术后常见并发症之一，其发病率高达12.2%。第2页术后淋巴瘘旳危害如果解决不当，可导致患者血容量减少、电解质紊乱、淋巴细胞下降及低蛋白血症，引起继发伤口感染，导致截肢甚至危及生命。给患者带来了巨大旳思想承担和经济承担第3页淋巴液成分与组织液相似（含小分子蛋白和纤维蛋白原）第4页第5页淋巴瘘旳成因与防止形成条件：高压量多破口上臂过度活动低蛋白血症肿瘤分期电刀旳过度使用

淋巴打扫范畴旳扩大

防止术后注意休息充足术前准备改善手术操作第6页老式旳治疗抗生素引流法填塞法具体办法为向切口内塞入油纱条或碘伏纱条压紧，4~6天后取出，使漏管充足受压粘合。

营养疗法水，电解质，高蛋白

手术第7页治疗新进展复方泛影葡胺注射液治疗治疗原理：复方泛影葡胺注射液临床上重要用于多种造影检查，是一种高渗性液体，可在局部迅速形成高渗状态，使组织脱水，收缩淋巴管，粘合组织，在局部产生粘连，使假腔内淋巴液减少，达到阻塞淋巴管，治疗淋巴瘘旳效果。治疗长处：不压迫深部血管，不影响静脉压，可增进肉芽组织生长，加快伤口愈合，可被组织吸取，不留异物。治疗效果：办法简朴，疗效明显，注射2次后淋巴液明显减少，5次后可达到治愈旳目旳第8页

Lanreotideautogel90mgandlymphorrheapreventionafteraxillarynodedissectioninbreastcancer:AphaseIIIdoubleblind,randomized,placebo-controlledtrial.

AbstractAIM:TheaimofthisstudywastoassesstheefficacyofLanreotide（兰瑞肽）Autogel90mgPRtopreventlymphorrheaafteraxillarydissectioninbreastcancer.METHODS:APhaseIIIdouble-blind,randomized,placebo-controlledtrialwasperformedbetweenApril1st,2023,andDecember31st,2023.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.

第9页SomatostatininbreastcancerAbstractInman,somatostatin（生长抑素）isahormonemostlyproducedbyhypothalamus.Itplaysdifferentpartsinhormonalregulationthroughmanyspecificreceptorsinhumanbody.Ithasalsotwointerestingactionssuchasananti-secretoryactivity,mostlyonthegastrointestinalsystemandanantiproliferativeactionontumorcells.Manysyntheticsomatostatinanalogues,morestablethanthenaturalone,havebeendevelopedandarealreadyusedindigestivesurgerytotreatpostoperativedigestivefistula.Also,thedevelopmentofspecificpolyclonalantibodiesallowedtheidentificationoffivespecificsomatostatinreceptorsandtheirlocalizationindifferentcellspecies.Thepresenceofthefivereceptorsinbreastcancercellshasthanbeendemonstrated.Thepurposeofthisliteraturereviewistoclarifythepotentialantitumoreffectofsomatastatinanaloguesinbreastcancer;itsuseasapreventiveagentonlymphorrheaafterbreastsurgeryanditsemploymentinimagingforearlybreastcancerdetection.

第10页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（胶原）typeI(CellerateRXpowder)appearstoattenuatepostoperativelymphorrheainpatientsundergoingaxillarylymphadenectomyespeciallywhen>10lymphnodesareremoved.第11页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.Themeanpaini