组织工程与重建外科杂志

组织工程与重建外科杂志 ›› 2023, Vol. 19 ›› Issue (3): 242-.

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乳腺癌患者术后早期上肢淋巴水肿的发生率及影响因素分析

  

  • 出版日期:2023-06-01 发布日期:2023-07-05

The incidence and risk factors of breast cancer-related lymphedema

  • Online:2023-06-01 Published:2023-07-05

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摘要：

　目的　探讨乳腺癌患者术后上肢淋巴水肿发生率、淋巴水肿分期以及相关危险因素。方法　回顾性分析
2019 年 9 月 1 日至 2019 年 12 月 31 日期间 128 例接受腋窝淋巴结清扫术的乳腺癌患者资料。患者均为女性，年龄
29~81 岁（平均 49.0±6.8 岁）。术后 6 个月、12 个月、24 个月及 36 个月时随访，采用诺曼问卷和臂围测量，从主
观和客观两个角度评估乳腺癌患者术后上肢淋巴水肿情况及淋巴水肿治疗情况。采用 Logistic 二元回归模型分析乳
腺癌术后上肢淋巴水肿的影响因素。结果　乳腺癌术后 6 个月、12 个月、24 个月和 36 个月的上肢淋巴水肿比例分
别为 9.4%（12/128）、25.0%（32/128）、23.4%（30/128）、23.4%（30/128），诺曼问卷得出的结果为 12.5%、26.6%、
25.0%、25.0%。128 例患者中，最终 30 例诊断为乳腺癌术后上肢淋巴水肿，其中，Ⅰ、Ⅱ、Ⅲ期淋巴水肿的发生比
例分别为 15.6%、6.3% 和 1.6%。体重指数（BMI）、放疗、淋巴结阳性数目及手术方式在淋巴水肿及对照组中存在差异。
乳腺癌术后的 CDT 治疗及淋巴外科手术均对淋巴水肿有积极的治疗效果。结论　乳腺癌术后上肢淋巴水肿是患者
在腋窝清扫术后常见的并发症，多于术后 1 年内发生，术后 1 ～ 3 年内淋巴水肿的发病率无明显变化。BMI、放疗、
淋巴结阳性数目及手术方式均可能影响乳腺癌术后上肢淋巴水肿的发生。

关键词:

Abstract:

Objective　To explore the incidence rate, severity and risk factors of breast cancer-related lymphedema (BCRL)
among breast cancer survivors. Methods　Data collected from 128 patients underwent breast cancer operation during September
1 to December 31, 2019. All the patients were female, aging (49.0±6.8) years (29-81 years). The Norman questionnaire and arm
circumference measurement were used to evaluate the BCRL status and treatment status of breast cancer patients from subjective
and objective perspectives at 6, 12, 24 and 36 months after surgery separately. The influence of the correlation factors on BRCL
occurrence was analyzed by Logistic analysis. Results　BRCL incidences were 9.4%, 25%, 23.4% and 23.4% at 6, 12, 24, 36
months according to arm circumference measurement, while 12.5%, 26.6%, 25.0% and 25.0% by Norman questionnaire. Among the 128 patients, 30 were diagnosed with BCRL after breast cancer surgery, among which the incidence of stage Ⅰ
lymphedema, stage Ⅱ lymphedema and stage Ⅲ lymphedema were 15.6%, 6.3% and 1.6%, respectively. Age, body mass index (BMI)  radiotherapy, the number of positive lymph nodes and surgery method showed differences between the the BCRL group and control group. Both CDT or LVA showed improvement for the BCRL patients. Conclusion　BCRL is a common complication for
breast cancer patients after surgery. It can be fairly diagnosed in the first year after surgery without the increasing incidence of
BCRL over time throughout 3 years. BMI, radiotherapy were found to be independent risk factors in the development of BCRL in
this study.