Abstract | Uvod. Karcinom dojke predstavlja najčešći zloćudni tumor kod žena diljem svijeta, uključujući Hrvatsku gdje svake godine oboli oko 3000 žena. Liječenje karcinoma dojke obuhvaća kirurške zahvate, kemoterapiju, hormonsku terapiju i imunoterapiju. Kirurški zahvati, uključujući odstranjenje dijela ili cijele dojke te limfnih čvorova iz pazuha, često zahtijevaju postavljanje drenaže kako bi se kontrolirao izlaz sukrvavog sadržaja i limfe iz rane. Dren ima ključnu ulogu u postoperativnom praćenju i olakšava detekciju komplikacija poput krvarenja. U većini slučajeva, dren se uklanja unutar prvih 24 do 48 sati nakon operacije, osim u situacijama gdje se izlučivanje ne smanji ispod 50 ml u 24 sata, što se može dogoditi kod disekcije aksile ili rekonstrukcije dojke. Suvremena kirurgija dojke također je usmjerena na smanjenje radikalnosti u odstranjenju limfnih čvorova, što može rezultirati smanjenim stvaranjem seroma u postoperativnom razdoblju.
Cilj. Cilj ovog rada je ispitati povezanost duljine drenaže i stvaranja seroma nakon operacija limfnih čvorova aksile u bolesnica s karcinomom dojke. U istraživanju su uspoređene razlike u vađenju drena do 48 sati u odnosu na vađenje nakon 48 sati.
Metode. Istraživanje je provedeno na Zavodu za onkoplastičnu i rekonstruktivnu kirurgiju, Klinike za tumore, Kliničkog bolničkog centra Sestre milosrdnice. Uključilo je 100 bolesnica podvrgnutih operativnom zahvatu na aksilarnim limfnim čvorovima. Polovini ispitanica dren je izvađen unutar 48 sati nakon operacije, dok je drugoj polovini dren izvađen nakon 48 sati. Količina seroma nakon vađenja drena praćena je na kontrolnim terminima za 5-7 i 14 dana nakon operacije, s potrebnim punktiranjem i evakuacijom. Dobiveni rezultati su deskriptivno i grafikonički prikazani za obje skupine bolesnica. Za ispitivanje hipoteze H analizirane su razlike u količini seroma između dviju skupina (dren izvađen nakon 24-48 sati i nakon 48 sati), te je izračunat relativni rizik (RR) za produženo stvaranje seroma.
Rezultati. Rezultati su pokazali značajnu razliku u distribuciji duljine drenaže prema tipu operacije i tipu operacije aksile. Kod ispitanica s duljinom drenaže dužom od 48 sati značajno je više bilo rekonstrukcija i poštednih operacija te se češće radila disekcija aksile. Također, postoji značajna pozitivna povezanost između broja izvađenih limfnih čvorova i količine
seroma nakon 5 - 7 dana te nakon 14 dana, što ukazuje na to da veći broj izvađenih limfnih čvorova rezultira većim nakupljanjem seroma.
Zaključak. Ovo istraživanje potvrdilo je jasnu povezanost između duljine primjene drenaže i formiranja seroma nakon operacija limfnih čvorova aksile kod bolesnica s karcinomom dojke. Potvrđena je početna hipoteza da dulja primjena drenaže rezultira većim nakupljanjem seroma. Naglašava se važnost pažljive procjene i planiranja postoperativne skrbi radi smanjenja rizika od seroma i povezanih komplikacija. Ovi rezultati pružaju temelj za daljnja istraživanja i razvoj novih strategija za sprječavanje formiranja seroma. Također rad ima doprinos kliničkoj praksi doprinoseći bolje razumijevanje za poboljšanje postoperativne skrbi i brige o seromu kod bolesnica s karcinomom dojke. |
Abstract (english) | Introduction: Breast cancer is the most common malignant tumor in women worldwide, including Croatia, where approximately 3,000 women are diagnosed with it each year. Breast cancer treatment involves surgical procedures, chemotherapy, hormone therapy, and immunotherapy. Surgical interventions, including partial or complete breast removal and axillary lymph node dissection, often require drainage to control the drainage of bloody content and lymph from the wound. Drains play a crucial role in postoperative monitoring and facilitate the detection of complications such as bleeding. In most cases, drains are removed within the first 24 to 48 hours after surgery, except in situations where the drainage does not decrease below 50 ml in 24 hours, which can occur during axillary dissection or breast reconstruction. Modern breast surgery also focuses on reducing the radical removal of lymph nodes, which can result in reduced seroma formation in the postoperative period.
Objective: The aim of this study is to examine the association between the duration of drainage and the formation of seroma following axillary lymph node dissection in breast cancer patients. The study compares differences in removing the drain within 48 hours versus removal after 48 hours.
Methods: The study was conducted at the Department of Oncoplastic and Reconstructive Surgery, Clinic for Tumors, Clinical Hospital Center Sisters of Mercy. It included 100 patients undergoing surgery on axillary lymph nodes. Half of the participants had the drain removed within 48 hours after surgery, while the other half had the drain removed after 48 hours. The amount of seroma after drain removal was monitored at follow-up appointments 5-7 and 14 days after surgery, with necessary punctures and evacuations. The obtained results were descriptively and graphically presented for both groups of patients. To test the hypothesis H, differences in the amount of seroma between the two groups (drain removed after 24-48 hours and after 48 hours) were analyzed, and the relative risk (RR) for prolonged seroma formation was calculated.
Results: The results showed a significant difference in the distribution of drain duration according to the type of surgery and axillary procedure. In patients with drain duration longer than 48 hours, there was a significantly higher prevalence of reconstructions and breast-conserving surgeries, and axillary dissection was more frequently performed. Additionally, there is a significant positive correlation between the number of removed lymph nodes and the amount of seroma after 5-7 days and after 14 days, indicating that a larger number of removed lymph nodes results in greater seroma accumulation.
Conclusion: This study confirmed a clear association between the duration of drainage application and the formation of seroma after axillary lymph node surgery in breast cancer patients. The initial hypothesis that longer drainage duration results in greater seroma accumulation was confirmed. The importance of careful assessment and planning of postoperative care to reduce the risk of seroma and related complications is emphasized. These results provide a basis for further research and the development of new strategies to prevent seroma formation. Additionally, the study contributes to clinical practice by enhancing understanding for improving postoperative care and seroma management in breast cancer patients. |