乳腺癌患者术后早期上肢淋巴水肿的发生率及影响因素分析

The incidence and risk factors of breast cancer-related lymphedema

目的探讨乳腺癌患者术后上肢淋巴水肿发生率、淋巴水肿分期以及相关危险因素。方法回顾性分析2019年9月1日至2019年12月31日期间128例接受腋窝淋巴结清扫术的乳腺癌患者资料。患者均为女性,年龄29~81岁(平均49.0±6.8岁)。术后6个月、12个月、24个月及36个月时随访,采用诺曼问卷和臂围测量,从主观和客观两个角度评估乳腺癌患者术后上肢淋巴水肿情况及淋巴水肿治疗情况。采用Logistic二元回归模型分析乳腺癌术后上肢淋巴水肿的影响因素。结果乳腺癌术后6个月、12个月、24个月和36个月的上肢淋巴水肿比例分别为9.4%(12/128)、25.0%(32/128)、23.4%(30/128)、23.4%(30/128),诺曼问卷得出的结果为12.5%、26.6%、25.0%、25.0%。128例患者中,最终30例诊断为乳腺癌术后上肢淋巴水肿,其中,Ⅰ、Ⅱ、Ⅲ期淋巴水肿的发生比例分别为15.6%、6.3%和1.6%。体重指数(BMI)、放疗、淋巴结阳性数目及手术方式在淋巴水肿及对照组中存在差异。乳腺癌术后的CDT治疗及淋巴外科手术均对淋巴水肿有积极的治疗效果。结论乳腺癌术后上肢淋巴水肿是患者在腋窝清扫术后常见的并发症,多于术后1年内发生,术后1~3年内淋巴水肿的发病率无明显变化。BMI、放疗、淋巴结阳性数目及手术方式均可能影响乳腺癌术后上肢淋巴水肿的发生。

Objective To explore the incidence rate,severity and risk factors of breast cancer-related lymphedema(BCRL)among breast cancer survivors.Methods Data collected from 128 patients underwent breast cancer operation during September 1 to December 31,2019.All the patients were female,aging(49.0±6.8)years(29-81 years).The Norman questionnaire and arm circumference measurement were used to evaluate the BCRL status and treatment status of breast cancer patients from subjective and objective perspectives at 6,12,24 and 36 months after surgery separately.The influence of the correlation factors on BRCL occurrence was analyzed by Logistic analysis.Results BRCL incidences were 9.4%,25%,23.4%and 23.4%at 6,12,24,36 months according to arm circumference measurement,while 12.5%,26.6%,25.0%and 25.0%by Norman questionnaire.Among the 128 patients,30 were diagnosed with BCRL after breast cancer surgery,among which the incidence of stageⅠlymphedema,stageⅡlymphedema and stageⅢlymphedema were 15.6%,6.3%and 1.6%,respectively.Age,body mass index(BMI)radiotherapy,the number of positive lymph nodes and surgery method showed differences between the the BCRL group and control group.Both CDT or LVA showed improvement for the BCRL patients.Conclusion BCRL is a common complication for breast cancer patients after surgery.It can be fairly diagnosed in the first year after surgery without the increasing incidence of BCRL over time throughout 3 years.BMI,radiotherapy were found to be independent risk factors in the development of BCRL in this study.