多频生物电阻抗分析在乳腺癌术后淋巴水肿患者分期手术疗效评价中的应用  

Application of multiple frequency bioelectrical impedance analysis in evaluation of the effect of staged surgery on breast cancer-related lymphedema

作　　者：刘昕 沈文彬 夏松 孙宇光 常鲲 信建峰 安然 刘中 LIU Xin;SHEN Wenbin;XIA Song;SUN Yuguang;CHANG Kun;XIN Jianfeng;AN Ran;LIU Zhong(Department of Lymphatic Surgery,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China)

机构地区：[1]首都医科大学附属北京世纪坛医院淋巴外科,北京100038

出　　处：《中华显微外科杂志》2024年第4期368-374,共7页Chinese Journal of Microsurgery

基　　金：科技创新2030-"新一代人工智能"重大项目(2020AAA0105005)

摘　　要：目的探讨多频生物电阻抗分析(MFBIA)在乳腺癌术后淋巴水肿(BCRL)的联合手术治疗中的应用意义。方法回顾性分析2021年4月至10月于首都医科大学附属北京世纪坛医院淋巴外科住院的30例单侧BCRL患者行分期脂肪抽吸术与淋巴管静脉吻合术(LVA)治疗的临床资料,术后采用电话等方式进行随访,于术后1年及2年来院复诊,测量患者双上肢各部位周径、前臂及臂长度,计算肢体体积;同时进行MFBIA,记录肢体生物电阻抗、细胞外水(ECW)及细胞外水分比率(ECW/TBW)。应用SPSS 21.0进行统计学分析,以单因素重复测量方差分析检验联合手术前、后患肢体积及电阻抗分析仪各测量值的变化,再采用配对t检验进行两两比较;将手术前、后患肢健肢体积差值与电阻抗分析仪各测量值的差值、比率采用配对t检验进行两两比较,并进行Pearson相关性分析,以P<0.05为差异有统计学意义。结果脂肪抽吸术后患肢健肢体积差由术前的(1147±484)ml减小至(261±304)ml,体积差明显减小,差异有统计学意义(P<0.05),ECW、各频率电阻抗(1~1000 K)的变化均无统计学意义(P>0.05)。LVA术后患肢与健肢体积差进一步减小至(17±264)ml,较术前差异有统计学意义(P<0.05);患肢ECW由术前的(1.115±0.207)L减至(0.937±0.164)L,差异有统计学意义(P<0.05);ECW/TBW由(0.412±0.008)减至(0.405±0.007),差异有统计学意义(P<0.05);各频率生物电阻抗均显著增大,差异有统计学意义(P<0.05)。LVA术后患肢体积差与ECW差值正相关(相关系数0.602,P<0.05),与ECW/TBW差值正相关(相关系数0.560,P<0.05),与各频率电阻抗比值负相关(相关系数0.529~0.545,P<0.05)。结论在对BCRL患者的分期手术治疗中,通过应用MFBIA,发现淋巴脂肪抽吸术去除了肢体病变脂肪组织,使患肢体积明显减小,但是淋巴液瘀滞不缓解,肢体水肿无明显减轻,二期LVA术后淋巴液回流改善,肢体水肿缓解,体积接近健侧。MFBIA可用ObjectiveTo explore the significance of multiple frequency bioelectrical impedance analysis(MFBIA)in the combined surgical treatment of breast cancer-related lymphedema(BCRL).MethodsA retrospective analysis was conducted on the clinical data of 30 patients with unilateral postoperative BCRL.The patients recieved staged liposuction and lymphaticovenular anastomosis(LVA)from April to October 2021 at the Department of Lymphatic Surgery in Beijing Shijitan Hospital,Capital Medical University.After LVA surgery,patients were followed-up by telephone and other means,and asked to come to the hospital at 1 year and 2 years,respectively.The circumference of each part of the upper limbs,the length of forearm and arm were measured,and the limb volume was calculated.MFBIA were also performed to record limb bioelectrical impedance,extracellular water(ECW),and extracellular water ratios(ECW/TBW).SPSS 21.0 was used for statistical analysis.Clinical data of the patients were analysed by One-way Repeated Measurement Anova to examine the changes in volume of the affected arms before and after surgery and the changes in values collected by MFBIA.Subsequently,differences in the volumes and values of MFBIA of the affected arms before and after surgery,and the ratios of the above were analysed by paired t-test to compare each pair,then followed by Pearson correlation test.P<0.05 was considered statistically significant.ResultsAfter liposuction,the volume differences of affected and healthy arms were reduced from 1147 ml±484 ml before surgery to 261 ml±304 ml after surgery,which achieved a significant reduction with statistical significance(P<0.05).However,there were no significant changes in ECW or bioelectrical impedance at various frequencies(1-1000 K)(P>0.05).After LVA,the differences in volume of the affected and healthy arms further decreased to 17 ml±264 ml with statistical significance compared to that before surgery(P<0.05),ECW decreased from 1.115 L±0.207 L to 0.937 L±0.164 L with statistical significance(P<0.05),ECW/TBW

关 键 词：乳腺癌 淋巴水肿 脂肪抽吸术 淋巴静脉吻合术 多频生物电阻抗分析 

分 类 号：R737.9[医药卫生—肿瘤]