乳腺癌术后慢性疼痛的相关因素分析

Risk factors for chronic pain following breast cancer surgery

目的对乳腺癌术后患者作流行病学调查,探讨引起乳腺癌术后慢性疼痛(CPSP)的相关因素。方法对322例女性原发性乳腺癌术后患者进行为期9个月的随访调查,分别记录术后3、9个月的10项相关因素,并进行统计学分析。结果术后3、9个月的CPSP发生率分别为61.0%和56.2%,单因素相关分析显示,术后3个月的慢性疼痛相关因素包括:低龄、腋窝淋巴结清扫、中重度术后急性疼痛(VAS评分≥4)(均P<0.05),而到术后9个月CPSP的相关因素除上述3个因素外,还增加了术前疼痛(P<0.05)。logistic回归分析显示,乳腺癌术后CPSP的独立危险因素包括低龄、腋窝淋巴结清扫、中重度术后急性疼痛(均P<0.05)。结论在乳腺癌术后9个月内,术后CPSP的发生率高。减少手术尤其是相关神经的损伤,采取前哨淋巴结活检来替代传统的腋窝淋巴结清扫术式,对低龄患者进行积极干预,积极预防和减轻术后急性疼痛,可能可以减少术后CPSP的发生率,提高患者的生活质量。

Objective To investigate the risk factors of chronic pain after breast cancer surgery. Methods A total of 322 women with primary breast cancer and surgical treatment were retrospectively investigated. A 9-month follow-up survey after surgery was conducted and 10 related factors of chronic pain were recorded on 3 months and 9 months after surgery. The association of chronic pain after breast cancer surgery with each variable was evaluated by Logistic regression analysis. Results The incidence of chronic pain on 3 months and 9 months after surgery was 61.0% and 56.2%, respectively. The univariate correlation analysis showed that the chronic pain after 3 months associated with younger age, axillary lymph node dissection and moderate to severe acute postoperative pain （VAS≥4） （P〈0.05）; and preoperative pain syndrome was an additional factor related to chronic pain after 9 months （P〈0.05）. Logistic regression analysis showed that younger age, axillary lymph node dissection, moderate to severe acute postoperative pain were independent risk factors of chronic pain after breast cancer surgery （P〈0.05）. Conclusion The incidence of chronic pain after breast cancer surgery is high, which is associated with younger age, axillary lymph node dissection and moderate to severe acute postoperative pain.