术前桡静脉压测定预测乳腺癌患者术后淋巴水肿的临床研究及其对胸大肌肌瓣转移术的理论价值

Preoperative Measurement of Radial Venous Pressure for Predicting Postoperative Breast Cancer-related Lymphedema and Its Theoretical Value for Pectoralis Major Muscle Flap Autograft

目的研究术前上肢桡静脉压的测定对乳腺癌患者术后上肢淋巴水肿的预测能力。方法第一阶段对我院2009年9月至2015年6月期间75例术后出现淋巴水肿的行乳腺癌改良根治术的患者进行双上肢桡静脉压的测定和上臂围的测量。第二阶段再对我院2015年7月至2017年5月期间157例行乳腺癌改良根治术的患者在术前、术后6个月、术后12个月分别进行双侧上肢桡静脉压检测和双侧上臂围的测量,记录两臂桡静脉压差值及上臂围的变化,同时记录患者淋巴结阳性数目。结果经过随访和统计分析,在第一阶段75例淋巴水肿患者中,术后上臂围差值与桡静脉压差明显正相关,P=0. 000。第二阶段中患者术前桡静脉压差值与术后淋巴结阳性数目存在正相关,P=0. 000;且术前桡静脉压差值较大的患者,术后6个月和12个月的上臂围差与术前比较,其差异具有统计学意义,P=0. 000;而术前桡静脉压差值较小的患者,术后6个月和12个月的上臂围差与术前比较,其差异没有统计学意义,P> 0. 05。同时发现,术前桡静脉压差值越高,术后淋巴水肿的程度越重,两者呈正相关,P=0. 000。结论术前桡静脉压的检测可以提前筛选出术后淋巴水肿发生风险较高的乳腺癌患者,从而在手术时可以通过行乳腺癌改良根治术加胸大肌肌瓣转移术,来降低乳腺癌术后患侧上肢淋巴水肿的发生,避免盲目加行胸大肌肌瓣转移术,从而造成不必要的损伤。

Objective To investigate the predictive value of measurement of radial vein pressure before modified radical mastectomy in the breast cancer-related lymphedema(BCRL). Methods In the first stage,75 patients with BCRL in our hospital from September 2009 to June 2015 were recruited.It was measured of the pressure of both radial veins and the circumference of the bilateral upper arms.Then,in the second stage,157 breast cancer patients were recruited from July 2015 to May 2017.It was measured of the pressure of both radial veins and the circumference of the bilateral upper arms before modified radical mastectomy and 6 months and 12 months after surgery.Meanwhile,the number of positive lymph nodes was recorded. Results In the first stage,it was found that the circumference of the upper arm was related to the pressure of radial vein(P=0.000).In the second stage,it was found that the pre-operative pressure of radial vein was related to the number of positive lymph nodes(P=0.000).Meanwhile,the percentage of the patients who had higher pressure in radial vein before surgery had higher incidence of BCRL(P=0.000).In addition,the lymphedema stage was also related to the pressure of radial vein(P=0.000). Conclusion Measurement of radial vein pressure before modified radical mastectomy may screen out the patients who have higher risk with breast cancer-related lymphedema,which may be the indication of pectoralis major myocutaneous flap autograft in modified radical mastectomy to reduce the chances of upper limb lymphedema,and also avoiding using it blindly.