淋巴漏淋巴漏專題宣講第1頁淋巴漏定義乳腺癌術后3~4天，臨床表現為切口引流管內每日約有200~500ml淡黃色淋巴液流出或拔除引流后管口、切口有大量液體滲出，經久不愈，則可稱為淋巴漏。乳腺癌術后常見并發癥之一，其發病率高達12.2%。淋巴漏專題宣講第2頁術后淋巴瘺危害假如處理不妥，可造成患者血容量降低、電解質紊亂、淋巴細胞下降及低蛋白血癥，引發繼發傷口感染，造成截肢甚至危及生命。給患者帶來了巨大思想負擔和經濟負擔淋巴漏專題宣講第3頁淋巴液成份與組織液相同（含小分子蛋白和纖維蛋白原）淋巴漏專題宣講第4頁淋巴漏專題宣講第5頁淋巴瘺成因與預防形成條件：高壓量多破口上臂過分活動低蛋白血癥腫瘤分期電刀過分使用

淋巴清掃范圍擴大

預防術后注意休息充分術前準備改進手術操作淋巴漏專題宣講第6頁傳統治療抗生素引流法填塞法詳細方法為向切口內塞入油紗條或碘伏紗條壓緊，4~6天后取出，使漏管充分受壓粘合。

營養療法水，電解質，高蛋白

手術淋巴漏專題宣講第7頁治療新進展復方泛影葡胺注射液治療治療原理：復方泛影葡胺注射液臨床上主要用于各種造影檢驗，是一個高滲性液體，可在局部快速形成高滲狀態，使組織脫水，收縮淋巴管，粘合組織，在局部產生粘連，使假腔內淋巴液降低，到達阻塞淋巴管，治療淋巴瘺效果。治療優點：不壓迫深部血管，不影響靜脈壓，可促進肉芽組織生長，加緊傷口愈合，可被組織吸收，不留異物。治療效果：方法簡單，療效顯著，注射2次后淋巴液顯著降低，5次后可到達治愈目標淋巴漏專題宣講第8頁

Lanreotideautogel90mgandlymphorrheapreventionafteraxillarynodedissectioninbreastcancer:AphaseIIIdoubleblind,randomized,placebo-controlledtrial.

AbstractAIM:TheaimofthisstudywastoassesstheefficacyofLanreotide（蘭瑞肽）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.

淋巴漏專題宣講第9頁SomatostatininbreastcancerAbstractInman,somatostatin（生長抑素）isahormonemostlyproducedbyhypothalamus.Itplaysdifferentpartsinhormonalregulationthroughmanyspecificreceptorsinhumanbody.Ithasalsotwointerestingactionssuchasananti-secretoryactivity,mostlyonthegastrointestinalsystemandanantiproliferativeactionontumorcells.Manysyntheticsomatostatinanalogues,morestablethanthenaturalone,havebeendevelopedandarealreadyusedindigestivesurgerytotreatpostoperativedigestivefistula.Also,thedevelopmentofspecificpolyclonalantibodiesallowedtheidentificationoffivespecificsomatostatinreceptorsandtheirlocalizationindifferentcellspecies.Thepresenceofthefivereceptorsinbreastcancercellshasthanbeendemonstrated.Thepurposeofthisliteraturereviewistoclarifythepotentialantitumoreffectofsomatastatinanaloguesinbreastcancer;itsuseasapreventiveagentonlymphorrheaafterbreastsurgeryanditsemploymentinimagingforearlybreastcancerdetection.

淋巴漏專題宣講第10頁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（膠原）typeI(CellerateRXpowder)appearstoattenuatepostoperativelymphorrheainpatientsundergoingaxillarylymphadenectomyespeciallywhen>10lymphnodesareremoved.淋巴漏專題宣講第11頁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