乳腺癌患者术后并发淋巴水肿的危险因素分析  

Risk factors for postoperative lymphedema in breast cancer patients

作　　者：刘祥伟 曲延玉 陈德滇[3] Liu Xiangwei;Qu Yanyu;Chen Dedian(Department of Breast Surgery,First People′s Hospital of Foshan of Guangdong Province,Foshan 528000,Chin)

机构地区：[1]广东省佛山市第一人民医院乳腺外科,528000 [2]广东省佛山市顺德中医院病理科 [3]云南省肿瘤医院乳腺外科

出　　处：《国际肿瘤学杂志》2018年第5期262-268,共7页Journal of International Oncology

摘　　要：目的探讨乳腺癌患者术后并发淋巴水肿的危险因素。方法收集2012年1月—2016年5月佛山市第一人民医院乳腺外科收治的行手术治疗的350例乳腺癌患者的病例资料。根据术后淋巴水肿的发生情况，将患者分为淋巴水肿组87例和非淋巴水肿组263例。从一般人口学指标、乳腺癌病理资料、围手术期相关资料、预防行为执行等方面评价淋巴水肿发生的危险因素。结果一般人口学资料：淋巴水肿的发生与患者年龄、术前身体质量指数（BMI）、术后BMI、文化程度、婚姻状况、居住地、家庭收入、术前是否绝经、高血压病史等一般人口学资料均无相关关系（均P＞0.05）。病理资料：淋巴水肿的发生与肿瘤象限（χ2=20.039，P＜0.001）、腋窝淋巴结转移数目（Z=4.713，P＜0.001）相关，但与肿瘤分期、病理类型无关（均P≥0.05）。围手术期相关资料：淋巴水肿的发生与手术切口类型（χ2=16.921，P＜0.001）、腋窝淋巴结清扫级别（χ2=4.433，P＜0.001）、腋窝淋巴结清扫数目（Z=3.620，P＜0.001）、放疗（χ2=33.290，P＜0.001）、内分泌治疗（χ2=10.428，P=0.001）相关，但与手术方式、术后并发症（皮下积液、上肢水肿、感染、血清肿）、是否行化疗、新辅助化疗无关（均P＞0.05）。预防行为执行比较：避免割伤咬伤等损伤（χ2=15.754，P＜0.001）、修剪指甲避免损伤（χ2=9.018，P=0.003）、不抓取重物（χ2=11.828，P=0.001）等预防行为的执行程度与术后淋巴水肿发生相关，但其他预防行为未表现出明显相关性（均P＞0.05）。以淋巴水肿发生与否为因变量，行多因素logistic回归分析，结果发现肿瘤位于外上象限（OR=3.943，P＜0.001）、手术切口为纵切口（OR=3.767，P＜0.001）或斜切口（OR=2.492，P＜0.001）、Ⅱ级（OR=1.707，P=0.003）或Ⅲ级（OR=4.211，P＜0.001）腋窝淋巴结清扫、行乳房/胸壁（OR=2.ObjectiveTo investigate the risk factors of lymphedema in patients with breast cancer after operation. MethodsFrom January 2012 to May 2016, the clinical data of 350 patients with breast cancer who underwent surgical treatment in First People′s Hospital of Foshan were collected. According to the occurrence of postoperative lymphedema, the patients were divided into lymphedema group （87 cases） and non lymphedema group （263 cases）. The possible risk factors were evaluated from general demographic indicators, pathological data of breast cancer, perioperative related data and preventive action implementation. Results General demographic data： there was no correlation between the incidence of lymphedema and age, preoperative body mass index （BMI）, postoperative BMI, educational level, marital status, residence, family income, menopause, hypertension history （P＞0.05）. Pathological data of breast cancer： the occurrence of lymphedema was related with tumor quadrant （χ2=20.039, P＜0.001） and axillary lymph node metastasis （Z=4.713, P＜0.001）, but not related with clinical stage and pathological type of tumor （both P≥0.05）. Perioperative data： the occurrence of lymphedema was related with the type of incision （χ2=16.921, P＜0.001）, axillary lymph node dissection level （χ2=4.433, P＜0.001）, the number of axillary lymph node dissection （Z=3.620, P＜0.001）, radiotherapy （χ2=33.290, P＜0.001）, endocrine therapy （χ2=10.428, P=0.001）, but not related with surgical methods, postoperative complications （subcutaneous fluid, upper limbedema, infection, serum swelling）, chemotherapy and neoadjuvant chemotherapy （all P＞0.05）. Comparison of preventive behaviors： avoiding injuries such as cuts and bites （χ2=15.754, P＜0.001）, trimming nails （χ2=9.018,P=0.003）, avoiding grasping heavy objects （χ2=11.828, P=0.001） were related with postoperative lymphedema, but other preventive behaviors did not show significant correlation （al

关 键 词：乳腺肿瘤 淋巴水肿 危险因素 

分 类 号：R737.9[医药卫生—肿瘤]