实用医学杂志 ›› 2023, Vol. 39 ›› Issue (12): 1500-1505.doi: 10.3969/j.issn.1006⁃5725.2023.12.007

• 临床研究 • 上一篇    下一篇

窄型无菌驱血止血套环在上肢淋巴水肿抽吸术中的应用 

郝昆1 孙宇光1 信建峰1 刘璇2 张丽3 李滨4 王仁贵5 沈文彬1    

  1. 首都医科大学附属北京世纪坛医院1 淋巴外科,2 输血科,3 核医学科,4 磁共振室, 5 普通放射科(北京 100038)
  • 出版日期:2023-06-25 发布日期:2023-06-25
  • 通讯作者: 沈文彬 E⁃mail:shenwb@bjsjth.cn
  • 基金资助:
    国家自然科学基金项目(编号:61876216);首都医科大学附属北京世纪坛医院院青年基金项目(编号:2022⁃q16)

Application of narrow sterile hemostatic ring in upper limb lymphedema aspiration 

HAO Kun,SUN Yu⁃ guang,XIN Jianfeng,LIU Xuan,ZHANG Li,LI Bin,WANG Rengui,SHEN Wenbin.   

  1. Department of Lymphatic Surgery,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China
  • Online:2023-06-25 Published:2023-06-25
  • Contact: SHEN Wenbin E⁃mail:shenwb@bjsjth.cn

摘要:

目的 评估一种新型窄型无菌驱血止血套环对上肢淋巴水肿抽吸术中失血的影响。 方法 回顾不同抽吸术治疗的 150 例上肢淋巴水肿患者的临床资料。第 1 组采用驱血止血套环和自体输 血的情况下进行手术。第 2 组未采用驱血止血套环和未采用自体输血的情况下进行手术。第 3 组采用驱 血止血套环和未采用自体输血的情况下进行手术。第 4 组未采用驱血止血套环和采用自体输血的情况下 进行手术。比较不同组患者的失血量,手术疗效和术后并发症情况。结果 止血套环抽吸组(第 1 组和第 3 组)血红蛋白下降值(16.90 ± 8.45)g/L,失血量(328.43 ± 171.54)mL,常规抽吸组(第 2 组和第 4 组)血红蛋 白下降值(20.95 ± 9.55)g/L,失血量(442.42 ± 172.08)mL,止血套环抽吸组和常规抽吸组中的血红蛋白下 降值和失血量指标相比差异有统计学意义(P < 0.05),采用窄型无菌驱血止血套环可明显减少失血量。 自体血组(第 1 组和第 4 组)血红蛋白下降值(18.42 ± 8.75)g/L,失血量(381.00 ± 194.02)mL,非自体血组 (第2组和第3组)血红蛋白下降值(20.15 ± 9.64)g/L,失血量(415.00 ± 171.96)mL,两组血红蛋白下降值和失 血量指标相比差异无统计学意义(P > 0.05),采用自体输血对患者失血量和术后血红蛋白下降值无明 显影响。第 1 组的手术时间(97.82 ± 24.90)min,第 2 组的手术时间(97.74 ± 22.48)min,第 3 组的手术时间 (88.83 ± 21.06)min,第 4 组的手术时间(104.82 + 16.25)min,差异无统计学意义(P > 0.05),采用窄型无菌 驱血止血套环和自体输血未增加手术时间。第 1 组的吸出脂肪量(1 380.77 ± 482.81)mL,第 2 组的吸出脂 肪量(1 122.95 ± 382.43)mL,第 3 组的吸出脂肪量(1 275.00 ± 478.87)mL,第 4 组的吸出脂肪量(1 272.73 ± 610.07)mL,差异有统计学意义(P < 0.05),采用窄型无菌驱血止血套环和自体输血可以明显增加脂肪组织 抽吸量。不同组患者术后均出现不同程度的肢体感觉异常和运动幅度受限,差异无统计学意义(P > 0.05)。 结论 新型窄型无菌驱血止血套环在上肢淋巴水肿抽吸术中的应用是安全的,可以有效减少失血量。 

关键词: 淋巴水肿, 失血, 止血带, 肿胀技术吸脂术, 自体输血, 输血

Abstract:

Objective To evaluate the effect of a new type of narrow sterile hemostatic ring on blood loss during upper limb lymphedema aspiration. Methods 150 patients with upper limb lymphedema were treated with four different types of aspiration. In the first group,the operation was performed under the condition of hemostasis ring and autotransfusion. In the second group,the operation was performed without the use of hemostasis ring and autotransfusion. In the third group,the operation was performed with the hemostatic ring and without autotransfusion. In the fourth group,the operation was performed without the use of hemostasis ring and autotransfusion. The blood loss,surgical effect and postoperative complications of patients in different groups were compared. Results In the hemostatic ring aspiration group(Group 1 and Group 3),the hemoglobin decrease was(16.90 ± 8.45)g/L,and the blood loss was(328.43 ± 171.54)mL. In the conventional aspiration group(Group 2 and Group 4),the hemoglobin decrease was(20.95 ± 9.55)g/L,and the blood loss was(442.42 ± 172.08)mL. The hemoglobin decrease and the blood loss index in the hemostatic ring aspiration group and the conventional aspiration group were statistically significant(P < 0.05),Using a narrow sterile hemostatic collar can significantly reduce blood loss. The hemoglobin decrease(18.42 ± 8.75)g/L and blood loss(381.00 ± 194.02)mL were observed in the autologous blood group (Group 1 and Group 4),while the hemoglobin decrease(20.15 ± 9.64)g/L and blood loss(415.00 ± 171.96)mL were observed in the non autologous blood group(Group 2 and Group 3). There was no statistically significant difference in the hemoglobin decrease and blood loss indicators between the two groups(P > 0.05),The use of autologous blood transfusion has no significant impact on blood loss and postoperative hemoglobin decline in patients. The surgical time for group 1 was(97.82 ± 24.90)min,for group 2 was(97.74 ± 22.48 )min,for group 3 was (88.83 ± 21.06)min,and for group 4 was(104.82 ± 16.25)min,with no statistically significant difference(P > 0.05). The use of narrow sterile hemostatic ring and autologous blood transfusion did not increase the surgical time. The amount of fat sucked out in group 1 was(1 380.77 ± 482.81)mL,the amount of fat sucked out in group 2 was (1 122.95 ± 382.43)mL,the amount of fat sucked out in group 3 was(1 275.00 ± 478.87)mL,and the amount of fat sucked out in group 4 was(1 272.73 ± 610.07)mL,with a statistically significant difference(P < 0.05). Using a narrow sterile hemostatic collar and autologous blood transfusion can significantly increase the amount of fat tissue sucked out. After surgery,patients in different groups experienced different degrees of limb sensory abnor⁃ malities and limited range of motion,with no statistically significant difference(P > 0.05). Conclusions The use of narrow sterile hemostatic ring for upper limb lymphedema aspiration can effectively reduce the amount of bleeding. 

Key words: lymphedema, lose blood, tourniquet, swelling technique liposuction, autotransfu? sion, blood transfusion