中国骨与关节杂志
中國骨與關節雜誌
중국골여관절잡지
Chinese Journal of Bone and Joint
2015年
1期
31-34
,共4页
李先安%刘剑帆%徐学政%欧阳正晓
李先安%劉劍帆%徐學政%歐暘正曉
리선안%류검범%서학정%구양정효
外科皮瓣%淋巴结切除术%腹股沟%外科伤口感染%坏死%黑色素瘤
外科皮瓣%淋巴結切除術%腹股溝%外科傷口感染%壞死%黑色素瘤
외과피판%림파결절제술%복고구%외과상구감염%배사%흑색소류
Surgical lfaps%Lymph node excision%Groin%Surgical wound infection%Necrosis%Melanoma
目的：探讨股前外侧肌皮瓣在腹股沟淋巴结清扫术中的应用对腹股沟淋巴结清扫术后的淋巴管瘘、切口感染及皮肤坏死等并发症的影响，为临床预防腹股沟淋巴结清扫的术后感染提供依据。方法对2005年8月至2013年7月，我科收治的下肢恶性黑色素瘤患者73例均行腹股沟淋巴结清扫术。其中行常规腹股沟淋巴结清扫术的33例为对照组；行腹股沟淋巴结清扫术联合应用股前外侧肌皮瓣移植的40例为实验组。对2组术后的淋巴管瘘、切口感染及皮肤坏死等情况进行随访和比较，并观察术后皮瓣情况。结果73例均获随访，随访时间为6个月至2年，中位随访时间1年。实验组中发生术后淋巴管瘘3例(7.5%)、切口感染1例(2.5%)、皮肤坏死2例(5.0%)；而对照组中发生术后淋巴管瘘12例(36.4%)、切口感染10例(30.3%)、皮肤坏死11例(33.1%)；且实验组淋巴管瘘、切口感染、皮肤坏死的发生率均明显小于对照组，差异有统计学意义( P＜0.05)。术后1个月，皮瓣色泽红润、皮温正常、质地柔软、未见红肿及流血流脓。结论腹股沟淋巴结清扫术中应用股前外侧肌皮瓣能有效减轻腹股沟淋巴结清扫术后的淋巴管瘘、切口感染及皮肤坏死等并发症的发生，对临床预防腹股沟淋巴结清扫的术后感染起积极作用。
目的：探討股前外側肌皮瓣在腹股溝淋巴結清掃術中的應用對腹股溝淋巴結清掃術後的淋巴管瘺、切口感染及皮膚壞死等併髮癥的影響，為臨床預防腹股溝淋巴結清掃的術後感染提供依據。方法對2005年8月至2013年7月，我科收治的下肢噁性黑色素瘤患者73例均行腹股溝淋巴結清掃術。其中行常規腹股溝淋巴結清掃術的33例為對照組；行腹股溝淋巴結清掃術聯閤應用股前外側肌皮瓣移植的40例為實驗組。對2組術後的淋巴管瘺、切口感染及皮膚壞死等情況進行隨訪和比較，併觀察術後皮瓣情況。結果73例均穫隨訪，隨訪時間為6箇月至2年，中位隨訪時間1年。實驗組中髮生術後淋巴管瘺3例(7.5%)、切口感染1例(2.5%)、皮膚壞死2例(5.0%)；而對照組中髮生術後淋巴管瘺12例(36.4%)、切口感染10例(30.3%)、皮膚壞死11例(33.1%)；且實驗組淋巴管瘺、切口感染、皮膚壞死的髮生率均明顯小于對照組，差異有統計學意義( P＜0.05)。術後1箇月，皮瓣色澤紅潤、皮溫正常、質地柔軟、未見紅腫及流血流膿。結論腹股溝淋巴結清掃術中應用股前外側肌皮瓣能有效減輕腹股溝淋巴結清掃術後的淋巴管瘺、切口感染及皮膚壞死等併髮癥的髮生，對臨床預防腹股溝淋巴結清掃的術後感染起積極作用。
목적：탐토고전외측기피판재복고구림파결청소술중적응용대복고구림파결청소술후적림파관루、절구감염급피부배사등병발증적영향，위림상예방복고구림파결청소적술후감염제공의거。방법대2005년8월지2013년7월，아과수치적하지악성흑색소류환자73례균행복고구림파결청소술。기중행상규복고구림파결청소술적33례위대조조；행복고구림파결청소술연합응용고전외측기피판이식적40례위실험조。대2조술후적림파관루、절구감염급피부배사등정황진행수방화비교，병관찰술후피판정황。결과73례균획수방，수방시간위6개월지2년，중위수방시간1년。실험조중발생술후림파관루3례(7.5%)、절구감염1례(2.5%)、피부배사2례(5.0%)；이대조조중발생술후림파관루12례(36.4%)、절구감염10례(30.3%)、피부배사11례(33.1%)；차실험조림파관루、절구감염、피부배사적발생솔균명현소우대조조，차이유통계학의의( P＜0.05)。술후1개월，피판색택홍윤、피온정상、질지유연、미견홍종급류혈류농。결론복고구림파결청소술중응용고전외측기피판능유효감경복고구림파결청소술후적림파관루、절구감염급피부배사등병발증적발생，대림상예방복고구림파결청소적술후감염기적겁작용。
Objective To investigate the effects on percutaneous lymphorrhagia, incision infection, cutaneous necrosis and other complications with the application of thigh anterolateral musculocutanious flap in inguinal lymphadenectomy, and to provide evidence for the clinical prevention of complications after inguinal lymphadenectomy.Methods A total of 73 patients with malignant melanoma of the lower limb underwent inguinal lymphadenectomy from August 2005 to July 2013, who were divided into 2 groups. Routine inguinal lymphadenectomy was performed on the patients in control group (n=33 ). The patients in experimental group (n=40 ) received thigh anterolateral musculocutaneous lfap and inguinal lymphadenectomy. The postoperative percutaneous lymphorrhagia, incision infection, cutaneous necrosis and other complications were analyzed and compared, and the postoperative lfaps were observed in both groups.Results All the patients were followed up from 6 months to 2 years, and the median follow-up time was 1 year. There were 3 cases of percutaneous lymphorrhagia ( 7.5% ), 1 case of incision infection ( 2.5% ) and 2 cases of cutaneous necrosis ( 5.0% ) in the experimental group. And 12 cases of percutaneous lymphorrhagia ( 36.4% ), 10 cases of incision infection ( 30.3% ) and 11 cases of cutaneous necrosis ( 33.1% ) were noticed in the control group. The incidence rate of complications in the experimental group was obviously lower than that in the control group, and the differences between then were statistically signiifcant (P<0.05 ). At 1 month after the operation, the flaps were ruddy and soft and their temperature was normal, without swelling, bleeding or purulence.Conclusions The incidence rate of percutaneous lymphorrhagia, incision infection, cutaneous necrosis and other complications will be effectively reduced with the application of thigh anterolateral musculocutanious lfap in inguinal lymphadenectomy, which plays an active role in the clinical prevention of complications after inguinal lymphadenectomy.
