老年乳腺癌患者术后上肢淋巴水肿的临床特点分析

Clinical Features of Upper-limb Lymphedema in the Elderly with Breast Cancer after Surgery

目的调查老年乳腺癌患者术后上肢淋巴水肿的发生情况、特点和相关危险因素,为其防治提供科学依据。方法选取2016年1月—2017年12月在复旦大学附属华山医院静安分院门诊随访的乳腺癌患者196例,将其中出现上肢淋巴水肿的98例作为研究对象,按照年龄分为老年组(≥60岁)和非老年组(<60岁),对2组采用问卷调查水肿发生诱因、症状及体征,并进行多因素Logistic回归分析相关危险因素。结果老年组淋巴水肿发生率高于非老年组(53.8%vs 45.7%),但差异无统计学意义(P>0.05);手术3年后老年组水肿发病率高于非老年组(10.7%vs 4.8%);老年组发生淋巴水肿诱因最多的是放疗置管后和做家务;老年组发生全臂水肿的比率高于非老年组(46.4%vs 26.0%);老年组中有17.9%的健患侧臂围差>6 cm,而非老年组的患者中仅有4.8%。结论老年乳腺癌术后上肢淋巴水肿具有发病率高、水肿范围广和程度重等特点,在预防与治疗的过程中需要更加关注。

Objective To explore the occurrence, features and related risk factors of upper-limb lymphedema in the elderly with breast cancer after surgery. Methods 98 cases with upper-limb lymphedema out the 196 follow-up outpatients with breast cancer during the period from Jan., 2016 to Dec., 2017 were selected and divided, according to age, into 2 groups： the elderly group （≥60 years older） and the non-elderly group （〈60 years old）; questionnaire survey on the inducement, symptoms and physical signs was performed in both group and multivariate logistic regression was made to analyze the related risk factors. Results The occurrence of lymphedema in the elderly group was higher than that in the non-elderly group （53.8 % vs 45.7 %） while the difference was of no statistical significance （P 〉 0.05）; 3 years after surgery, the occurrence of lymphedema in in the elderly group was higher than that in the non-elderly group （10.7% vs 4.8%）; the inducement of ly-mphedema in the elderly group mainly included tube indwelling after radiotherapy and housework; the occurrence of whole limb edema in the elderly group was higher than that in the non-elderly group （46.4% vs 26.0%）; 17.9% of the cases in the elderly group had the bilateral arm circumference difference over 6 cm while in the non-elderly group, only 4.8%. Conclusions The upper-limb lymphedema in the elderly with breast cancer after surgery is of higher occurrence, wider range edema and worse severity, attention should be paid in the prevention and treatment.