手术完毕,检查引流管是否通畅、有无漏气,如果切口处漏气,可用凡士林纱布覆盖,以免影响术后引流。
手术后6 h可饮水,术后第1天可进流质饮食(少量多次),术后第2天可进普通饮食。
引流管保持通畅,每天记录引流量及引流液性质,若引流量连续3天少于15 mL时,可考虑拔除引流管。一般先拔除普通硅胶管,后拔除腋窝高负压管,以免形成积液。
术后2天内患侧肩关节轻度内收,约45°制动,2天后逐渐开始练习上肢活动,肩关节可保持近90°,这样利于上肢功能的恢复。接受腋窝淋巴结清扫的患者术后切勿在患肢输液、测血压,切勿让患者提重物。
行腋窝淋巴结清扫的患者,术后患侧上肢功能锻炼,是治疗和护理过程的重要一环。一般可分为3个阶段进行,见图2-7。
图2-7 术后上肢功能锻炼
保乳的标准根据国家“十一五”攻关课题“早期乳腺癌规范化保乳综合治疗的临床研究”采用的美容评定标准:保乳治疗组的患者需分别于术后6个月、12个月及24个月进行乳房美容效果评估,并应随访3年,3年后乳房外形则趋于稳定。评价标准分3个等级,其中优良及一般,判定为满意;差,判定为不满意。Kelemen 等人就美容效果对61篇文献的荟萃分析显示,传统保乳手术组美容效果满意度低于保乳整形组美容效果满意度(82.9% vs 89.5%, P <0.001)。
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(编者:关利平 审校:罗康维)