乳腺癌腋窝淋巴结清扫术后上肢并发症结果分析

Analysis on the questionnaire of arm complications in breast cancer patients after operation

目的分析乳腺癌腋窝淋巴结不同清扫范围术后上肢并发症的发生情况。方法选择2001年1月至2007年1月于北京肿瘤医院乳腺中心乳腺癌资料完整452例患者，根据腋窝淋巴结清扫范围分为完全清扫组191例，部分清扫组261例，以问卷形式对患侧上肢水肿、肩关节运动障碍等上肢并发症进行调查，并进行统计学分析。结果452例患者中，上臂水肿65例（14．4％），前臂水肿33例（7．3％），其中完全清扫组上臂水肿发生率为14．6％（28／191），与部分清扫组的14．2％（37／261）相比，差异无统计学意义（P〉0．05）；完全清扫组和部分清扫组组间前臂水肿的发生率分别为6．3％（12／191）、8．0％（21／261），组间比较差异无统计学意义（P〉0．05）；完全清扫组肩外展、旋后障碍发生率为17．8％（34／191），与部分清扫组的19．5％（51／261）相比，差异无统计学意义（P〉0．05）；完全清扫组肩后伸、内旋障碍发生率为9．9％（19／191），与部分清扫组的8．8％（23／261）相比，差异无统计学意义（P〉0．05）。结论完全腋窝淋巴结清扫较部分腋窝淋巴结清扫的范围虽然有所扩大，但并未增加上肢水肿、肩关节功能障碍的发生率。

Objective To post-operatively investigate the incidence of the arm complications in breast cancer patients. Methods A total of 452 patients with breast cancer, including 191 patients with total axillary lymph node dissection and 261 patients with partial axillary lymph node dissection, were recruited from January 2001 to January 2007 in breast center of Beijing Cancer Hospital. The circumferences of upper arm and forearm on both ipsilateral and eontralateral sides in breast cancer patients post-operatively were acquired through questionnaires. Results Among 452 breast cancer patients in this study, incidences of upper arm and forearm edema after axillary dissection were 14.4% （65/452）and 7.3% （33/452）in total and partial axillary dissections respectively. Incidences of upper arm edema were 14.6% （28/191） and 14.2% （ 37/261 ） in total and partial axi!lary dissections respectively （P 〉 0.05 ） ; incidences of forearm edema were 6.3% （ 12/191 ） and 8.0% （21/261） in total and partial axillary dissections respectively （P 〉0.05 ） ; there were 17.8% （34/191） and 19.5% （51/261） in total and partial axillary dissections respectively （P〉 0..05 ） regarding combing malfunction （abduction and supination） ; 9.9% （ 19/191 ） and 8.8% （ 23/261 ） in total and partial axillary dissections were incapable of fastening hooks from back （afterward-stretching, intorsion）. Conclusion The range of axillary lymph node dissection is expanded in the group of total axillary lymph node dissection, which does not increase the incidence of upper limb edema and shoulder joint dysfunetion.