淋巴漏专题宣讲

淋巴漏淋巴漏专题宣讲第1页淋巴漏定义乳腺癌术后3~4天，临床表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%。淋巴漏专题宣讲第2页术后淋巴瘘危害假如处理不妥，可造成患者血容量降低、电解质紊乱、淋巴细胞下降及低蛋白血症，引发继发伤口感染，造成截肢甚至危及生命。给患者带来了巨大思想负担和经济负担淋巴漏专题宣讲第3页淋巴液成份与组织液相同（含小分子蛋白和纤维蛋白原）淋巴漏专题宣讲第4页淋巴漏专题宣讲第5页淋巴瘘成因与预防形成条件：高压量多破口上臂过分活动低蛋白血症肿瘤分期电刀过分使用

淋巴清扫范围扩大

预防术后注意休息充分术前准备改进手术操作淋巴漏专题宣讲第6页传统治疗抗生素引流法填塞法详细方法为向切口内塞入油纱条或碘伏纱条压紧，4~6天后取出，使漏管充分受压粘合。

营养疗法水，电解质，高蛋白

手术淋巴漏专题宣讲第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主要用于各种造影检验，是一个高渗性液体，可在局部快速形成高渗状态，使组织脱水，收缩淋巴管，粘合组织，在局部产生粘连，使假腔内淋巴液降低，到达阻塞淋巴管，治疗淋巴瘘效果。治疗优点：不压迫深部血管，不影响静脉压，可促进肉芽组织生长，加紧伤口愈合，可被组织吸收，不留异物。治疗效果：方法简单，疗效显著，注射2次后淋巴液显著降低，5次后可到达治愈目标淋巴漏专题宣讲第8页

Lanreotideautogel90mgandlymphorrheapreventionafteraxillarynodedissectioninbreastcancer:AphaseIIIdoubleblind,randomized,placebo-controlledtrial.

AbstractAIM:TheaimofthisstudywastoassesstheefficacyofLanreotide（兰瑞肽）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.

淋巴漏专题宣讲第9页SomatostatininbreastcancerAbstractInman,somatostatin（生长抑素）isahormonemostlyproducedbyhypothalamus.Itplaysdifferentpartsinhormonalregulationthroughmanyspecificreceptorsinhumanbody.Ithasalsotwointerestingactionssuchasananti-secretoryactivity,mostlyonthegastrointestinalsystemandanantiproliferativeactionontumorcells.Manysyntheticsomatostatinanalogues,morestablethanthenaturalone,havebeendevelopedandarealreadyusedindigestivesurgerytotreatpostoperativedigestivefistula.Also,thedevelopmentofspecificpolyclonalantibodiesallowedtheidentificationoffivespecificsomatostatinreceptorsandtheirlocalizationindifferentcellspecies.Thepresenceofthefivereceptorsinbreastcancercellshasthanbeendemonstrated.Thepurposeofthisliteraturereviewistoclarifythepotentialantitumoreffectofsomatastatinanaloguesinbreastcancer;itsuseasapreventiveagentonlymphorrheaafterbreastsurgeryanditsemploymentinimagingforearlybreastcancerdetection.

淋巴漏专题宣讲第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.淋巴漏专题宣讲第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.Themeanpainintensityat6w