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乳腺癌改良根治术后切口感染对患者凝血功能、炎症水平及淋巴水肿的影响

Influence of incision infection on the coagulation functions, inflammatory levels and lymphedema in patients with breast cancer after the modified radical mastectomy
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摘要 目的分析乳腺癌改良根治术后切口感染对患者凝血功能、炎症水平及乳腺癌相关淋巴水肿(BCRL)的影响,为医院感染的预防和控制工作提供证据。方法选取2014年5月-2019年5月淄博市中心医院行乳腺癌改良根治术患者156例作为研究对象,对其术后切口感染发生率进行记录和分析,根据是否发生切口感染将其分为感染组和未感染组。于术前24 h时、术后30 d时采集患者的静脉血样本,对凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)水平及血清白细胞介素(IL)-2、IL-6、肿瘤坏死因子-α(TNF-α)水平进行检测;对患者术后进行为期3个月的随访,对随访期内BCRL的发生率进行观察和分析。结果有14例患者发生切口感染,感染率为8.97%。在术后30 d时,两组患者的TT、PT、APTT水平及血清IL-2水平均较术前上升,FIB水平及血清IL-6、TNF-α水平较术前下降,差异均有统计学意义(P<0.05);在随访期内,感染组和未感染组分别有3例和4例发生BCRL,发生率分别为21.43%和2.82%,两组间差异有统计学意义(P<0.05)。结论改良根治术可使乳腺癌患者的系统性炎症和血液高凝状态得以缓解,但术后发生的切口感染可影响上述状态的术后恢复,并可能导致BCRL发生率的升高,临床医生应积极采取措施预防切口感染的发生,从而保证手术治疗效果、减少术后并发症。 OBJECTIVE To analyze the influence of incision infection on the coagulation functions, inflammatory levels and breast cancer-related lymphedema(BCRL) after the modified radical mastectomy in patients with breast cancer, to provide evidence for the prevention and control of nosocomial infections. METHODS Total of 156 breast cancer patients undergoing modified radical mastectomy from May of 2014 to May of 2019 were recruited as the study subjects. The incidence of the postoperative incision infection was recorded and analyzed. According to whether incision infection occurred, patients were divided into the infection group and the uninfected group. The venous blood samples were collected 24 hours before the operation and on 30 th day after the operation. The levels of prothrombin time(PT), activated partial thromboplastin time(APTT), thrombin time(TT), fibrinogen(FIB), serum interleukin(IL)-2, IL-6 and tumor necrosis factor-α(TNF-α) were detected. The patients were followed up for 3 months and the incidence of BCRL in the follow-up period was observed and analyzed. RESULTS The incision infection occurred in 14 patients, and the infection rate was 8.97%. On the 30 d after the operation, the levels of TT, Pt, APTT and serum IL-2 in the patients of the two groups increased compared with that before the operation;the levels of FIB, IL-6 and TNF-α in the patients of the two groups significantly decreased compared with that before the operation(P<0.05). During the follow-up period, BCRL occurred in 3 cases of the infection group and 4 cases of the uninfected group, the incidence rates were 21.43% and 2.82%, respectively;the difference between the two groups was significant(P<0.05). CONCLUSION The modified radical mastectomy can alleviate systemic inflammation and hypercoagulability in the patients with breast cancer, but the postoperative incision infection can hinder the postoperative recovery, and may lead to an increase in the incidence of BCRL. Clinicians should take active measures to prevent incision infection so
作者 高奎乐 李政 张秀清 朱美霖 司玉川 GAO Kui-le;LI Zheng;ZHANG Xiu-qing;ZHU Mei-lin;SI Yu-chuan(Zibo Central Hospital,Zibo,Shandong255036,China)
出处 《中华医院感染学杂志》 CAS CSCD 北大核心 2020年第16期2494-2497,共4页 Chinese Journal of Nosocomiology
基金 山东省医药卫生科技发展计划基金资助项目(ZR2012HL34)。
关键词 乳腺癌 根治术 切口感染 凝血功能 乳腺癌相关淋巴水肿 Breast cancer Radical mastectomy Incision infection Coagulation function Breast cancer-related lymphedema
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