局部组织水分检测在乳腺癌术后淋巴水肿诊断中的应用

Measurement of local tissue water in the diagnosis of breast cancer related lymphedema

目的探讨局部组织水分测试对乳腺癌术后淋巴水肿的诊断和评估价值。方法选取在北京协和医院就诊的乳腺癌术后淋巴水肿患者61例，采用组织介电常数方法测量患者双侧上臂和前臂腹侧及背侧中点的局部组织水分。同时用卷尺测量双侧上臂和前臂周径，分别计算患臂与健臂的局部组织水分比及周径比。结果前臂周径差≥2cm、上臂腹侧局部组织水分比≥1．2、前臂腹侧局部组织水分比≥1．2的患者比例分别为29．5％、39．3％和52．5％。患侧与健侧上臂和前臂腹侧局部组织水分比均明显大于其背侧局部组织水分比（P〈0．05）；患侧与健侧上臂和前臂周径比分别与其上臂和前臂局部组织水分比相关（P〈0．05）．特别是与腹侧局部组织水分比的相关系数较高；患者淋巴水肿分期也与其上臂和前臂局部组织水分比相关（P〈0．05），其中与前臂腹侧局部组织水分比的相关系数最高。结论局部组织水分检测对乳腺癌术后淋巴水肿有较好的早期诊断和定量评估价值，建议重点检查前臂腹侧部位。

Objective To investigate the value of local tissue water （LTW） in the diagnosis and evaluation for breast cancer related lymphedema （BCRL）. Methods Sixty one patients with BCRL in Peking Union Medical College Hospital were recruited. The tissue dielectric constant （TDC） method was used to measure the LTW of the ventral and dorsal midpoint of the bilateral upper arm and forearm of the patients. Meanwhile, the circumference of the bilateral upper arm and forearm was measured with a tape. The LTW ratio and the circumference ratio of the affected and the unaffected arms were calculated respectively. Results The percentage of the patients who had two centimeter or above difference in the same reference point between their affected and unaffected arms or had 1.2 or above LTW ratio in their ventral upper arm and forearm were 29.5% , 39.3% and 52.5% respectively. The LTW ratio of the ventral reference point between the affected arms and the unaffected arms was significantly higher than that of the dorsal reference point （ P 〈 0.05 ）. The circumference ratio was related to the LTW ratio between the affected arms and the unaffected arms （ P 〈 0.05 ）, especially the coefficient of the ventral LTW ratio was higher. The lymphedcma stage of the patients was also related to the LTW ratio of the upper arm and forearm （ P 〈 0. 05 ）, and the coefficient of the LTW ratio in the ventral forearm was the highest. Conclusions LTW measurement is helpful for early diagnosis and quantitative evaluation of BCRL. It is suggested that the ventral reference point of forearm should be examined.