乳腺癌患者两侧上肢周径生理性差异状况的研究

Physiological differences between the dominant and nondominant upper limbs circumferences of breast cancer patients

目的了解乳腺癌患者术前两侧上肢周径的生理性差异及其影响因素,为乳腺癌术后淋巴水肿诊断提供参考。方法采用便利抽样方法选择乳腺癌术前患者161例,采用上臂连续周径测量法测量上肢周径。使用配对t检验比较患者优势侧与非优势侧的周径差异,使用秩和检验分析年龄、体重指数与上肢周径差值的关系。结果患者优势侧与非优势侧上肢周径在手正中、腕横纹、横纹上4cm、横纹上16cm、横纹上20cm、横纹上24cm以及横纹上44cm 7个部位存在统计学差异(P<0.05,P<0.01);不同年龄、体重指数患者两侧上肢周径差值无统计学差异(均P>0.05)。结论乳腺癌患者两侧上肢周径主要受是否为优势侧影响,术后淋巴水肿的诊断应考虑患者术前两侧上肢的生理性差异。建议在术前常规测量两侧上肢周径,作为术后淋巴水肿评估的参考。

Objective To figure out the physiological differences between the dominant and nondominant upper limbs circumferences and its influential factors of breast cancer patients before operation,and to offer reference for diagnostic criteria of lymphedema after operation.Methods A total of 161 breast cancer patients before operation were selected through convenience sampling method,and their limbs circumferences were measured using circumferential limb measurement.Paired t test was used to compare the differences of the circumferences between the dominant and nondominant limbs,and rank-sum test was used to analyse the relationships of physiological differences with age and BMI.Results There were significant differences between the dominant and nondominant limbs at the hand metacarpals,the wrist stripe and 4 cm,16 cm,20 cm,24 cm,44 cm above the stripe（P〈0.05,P〈0.01）,while there were no significant differences of circumferences differences for patients with different age and BMI（P〉0.05 for all）.Conclusion The upper limbs circumferences of breast cancer patients are mainly influenced by arm dominance,and the physiological differences should be considered when diagnosing lymphedema after operation.It is recommended that circumferential limb measurement be included in the pre-operative assessment to offer references for lymphedema diagnosis after operation.