淋巴漏课件.pptVIP

淋巴漏的定义 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的管口、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%。 术后淋巴瘘的危害 如果处理不当，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，引发继发伤口感染，导致截肢甚至危及生命。给患者带来了巨大的思想负担和经济负担 淋巴瘘的成因与预防 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 电刀的过度使用 淋巴清扫范围的扩大 预防 术后注意休息 充分术前准备 改善手术操作 传统的治疗 抗生素 引流法 填塞法 具体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 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，治疗淋巴瘘的效果。 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，加快伤口愈合，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次后淋巴液明显减少，5次后可达到治愈的目的 Lanreotide autogel 90 mg and lymphorrheaprevention after axillary node dissection in breastcancer: A phase III double blind, randomized, placebo-controlled trial. Abstract AIM: The aim of this study was to assess the efficacy of Lanreotide（兰瑞肽） Autogel 90 mg PR to prevent lymphorrheaafter axillary dissection in breastcancer. METHODS: A Phase III double-blind, randomized, placebo-controlled trial was performed between April 1st, 2008, and December 31st, 2010. The primary endpoint was the lymphorrhea volume (ml) in the axillary drain during the first four postoperative days. The secondary end points were the number of days until axillary drain removal, hospital stay duration (days), lymphorrhea volume (ml) up to days 15, 30 and 180, number of cases with seroma aspiration and number of seroma aspirations, evaluation of wound, arm pain and mobility on days 15, 30 and 180. RESULTS: A total of 148 patients were recruited for the study. Altogether 145 patients were randomized and analysed on an inten