子宫颈癌术后下肢淋巴水肿的危险因素及对生活质量的影响

Risk Factors of Postoperative Lower Extremity Lymphedema in Cervical Cancer Patients and Its influence on Quality of Life

目的:探讨子宫颈癌术后下肢淋巴水肿(lower extremity lymphedema,LEL)的高危因素及对生活质量的影响。方法:回顾性选取2014年1月-2019年12月福建省肿瘤医院收治的949例子宫颈癌患者。采用妇科癌症淋巴水肿问卷(gynecologic cancer lymphedema questionnaire,GCLQ)评估下肢淋巴水肿。将下肢淋巴水肿患者按照国际淋巴学会制定标准进行进一步分级,分析发生下肢淋巴水肿的危险因素。采用第4版癌症患者生命质量测定量表共性模块(functional assessment of cancer therapy-generic scale,FACT-G)评估生活质量。结果:共有22.6%(214/949)患者出现下肢淋巴水肿,其中1级占63.1%(135/214),2级占18.7%(40/214),3级占18.2%(39/214)。平均术后第(7.3±1.2)个月发生下肢淋巴水肿。单因素分析表明年龄、术后辅助放疗、肿瘤分期、盆腔淋巴结清扫和淋巴结清扫数目与下肢淋巴水肿有关(P<0.05)。多因素分析表明,年龄、术后辅助放疗、盆腔淋巴结清扫和淋巴结清扫数目是下肢淋巴水肿独立危险因素(P<0.05)。下肢淋巴水肿患者生活质量的各个维度得分均低于非下肢淋巴水肿患者(P<0.05)。结论:子宫颈癌术后下肢淋巴水肿与多个因素有关,降低患者的生活质量,临床上需要加强对高危人群的管理以减少发生。

Objective:To discuss the high-risk factors of lower extremity lymphedema after cervical cancer surgery and its impact on the quality of life.Method:A total of 949 cervical cancer patients who were admitted to Fujian Cancer Hospital from January 2014 to December 2019 were retrospectively selected.The gynecologic cancer lymphedema questionnaire(GCLQ)was used to assess lower extremity lymphedema.Patients with lower extremity lymphedema were further classified according to the standards established by the international lymphatic society.Analyzed the risk factors for lower extremity lymphedema.The functional assessment of cancer therapy-generic scale(FACT-G)was used to assess the quality of life.Result:A total of 22.6%(214/949)patients had lower extremity lymphedema,of which grade 1 was 63.1%(135/214),grade 2 was 18.7%(40/214),and grade 3 was 18.2%(39/214).Lower extremity lymphedema occurred on average(7.3±1.2)months after operation.Univariate analysis showed that age,postoperative adjuvant radiotherapy,tumor stage,pelvic lymph node dissection and the number of lymph node dissection were related to lower extremity lymphedema(P<0.05).Multivariate analysis showed that age,postoperative adjuvant radiotherapy,pelvic lymph node dissection,and the number of lymph node dissection were independent risk factors for lower extremity lymphedema(P<0.05).The scores of all dimensions of quality of life of patients with lower extremity lymphedema were lower than those in patients with non-lower extremity lymphedema(P<0.05).Conclusion:Lower extremity lymphedema after cervical cancer surgery is related to many factors,reduce the quality of life of patients.It is necessary to strengthen the management of high-risk groups to reduce the occurrence.