基于多学科协作的预防性淋巴管-静脉吻合术在乳腺癌腋窝淋巴结清扫患者中的应用  

Application of preventive lymphaticovenular anastomosis in breast cancer patients with axillary lymph node dissection based on multidisciplinary collabration

作　　者：蒙燕[1] 唐如冰 蒋奕[1] 陆华[1] 苏玉兰 张琼 何英煜[1] Yan Meng;Rubing Tang;Yi Jiang;Hua Lu;Yulan Su;Qiong Zhang;Yingyu He(Department of Breast Surgery,the Affiliated Tumor Hospital of Guangxi Medical University,Nanning 530021,China)

机构地区：[1]广西医科大学附属肿瘤医院乳腺外科,南宁530021

出　　处：《中华损伤与修复杂志（电子版）》2024年第3期204-207,共4页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

摘　　要：目的观察多学科协作模式下行腋窝淋巴结清扫术(ALND)同期预防性淋巴管-静脉吻合术(LVA)对乳腺癌患者术后上肢淋巴水肿及生存质量的影响。方法选择2022年8月至2023年7月广西医科大学附属肿瘤医院乳腺外科收治的行ALND同期预防性LVA乳腺癌患者17例,通过建立多学科团队,实施术前多学科会诊、辅助患者决策、术后康复指导、"互联网+"管理的医疗模式。对患者上肢周径实施监测,并采用中文版世界卫生组织生存质量量表简表(WHOQOL-BREF)评估患者术后生存质量。结果随访9.60~19.30(12.74±2.51)个月。术前双上肢周径差值0.50(0.03,0.88)cm,末次随访时双上肢周径差值0.50(0.13,1.00)cm,17例患者行ALND术后均未出现肢体淋巴水肿,肩关节功能恢复良好。末次随访时患者生存质量生理领域得分为(15.40±2.37)分,心理领域得分为(16.64±2.19)分,社会关系领域得分为(14.80±2.66)分,环境领域得分为(15.43±2.12)分,心理领域得分最高。结论多学科协作模式下实施预防性LVA,可增加乳腺癌患者的治疗决策参与度,减少术后淋巴水肿的发生,提高患者生存质量。Objective To observe the effect of axillary lymph node dissection(ALND)and preventive lymphaticovenular anastomosis(LVA)on postoperative upper limb lymphedema and quality of life in patients with breast cancer based on the multidisciplinary callabration model.Methods A total of 17 patients with breast cancer who underwent ALND and preventive LVA admitted to the Department of Breast Surgery of Affiliated Tumor Hospital of Guangxi Medical University from August 2022 to July 2023 were entrolled.By establishing a multidisciplinary team,the medical model of preoperative multi-disciplinary treatment,assisting patient decision-making,postoperative rehabilitation guidance,and internet plus management were implemented.Monitored the circumference of the upper limbs and evaluated the postoperative quality of life using the Chinese version of the WHOQOL-BREF.Results The follow-up time was 9.60-19.30(12.74±2.51)months.The difference in the circumference of upper limbs was 0.50(0.03,0.88)cm before surgery and 0.50(0.13,1.00)cm at the last follow-up,no limb lymphedema occured after operation.At the last follow-up,the patient′s quality of life score was 15.40±2.37,16.64±2.19,14.80±2.66 and 15.43±2.12 in the physiological,psychological,social relations and environmental fields,respectively,and the highest scores was in the psychological fields.Conclusion Preventive LVA under the multidisciplinary callabration model can increase the participation of breast cancer patients in treatment decision-making,reduce the occurrence of postoperative lymphedema and improve the quality of life of patients.

关 键 词：乳腺癌 淋巴管-静脉吻合术 淋巴水肿 预防性治疗 多学科协作 

分 类 号：R737.9[医药卫生—肿瘤]