目的

探讨乳腺癌患者术后上肢淋巴水肿的发生率及危险因素。

方法

回顾性分析2006 年1 月至2014 年3 月在北京朝阳医院京西院区诊断为单侧乳腺癌并行乳腺癌改良根治术的348 例患者临床资料。 评估患者上肢淋巴水肿的发生情况,测定患肢上臂、前臂、手腕部周径差异,患肢周径超过健侧周径2 cm,即诊断为上肢淋巴水肿。 分析上肢淋巴水肿的相关危险因素,如年龄、体质指数、T 分期、腋窝淋巴结转移、腋窝淋巴结清扫范围、乳房切除方式、术后辅助放射治疗等,采用χ² 检验进行单因素分析,采用Logistic 回归分析方法进行多因素分析。

结果

在348 例患者中,有88 例(25.3%)被诊断为术后上肢淋巴水肿,260 例未发生上肢淋巴水肿。 患者术后5 年上肢淋巴水肿发生率为25.3%(88/348)。 单因素分析显示,在上肢淋巴水肿组患者中,年龄＞60 岁、体质指数≥25、腋窝淋巴结转移、淋巴结转移数目4 枚以上、行腋窝淋巴结清扫及放射治疗者分别占31.1%(46/148)、41.0%(43/105)、40.4%(53/131)、37.5%(33/88)、40.6%(88/247)、85.2%(23/27),明显高于非上肢淋巴水肿组的21%(42/42)、18.5%(45/243)、16.1%(35/217)、21.2%(55/260)、0(0/101)、20.2%(65/321),组间差异均有统计学意义(χ² =4.575、19.531、25.592、15.886、48.163、55.585,P 均＜0.050)。 多因素分析显示,体质指数、腋窝淋巴结清扫和术后腋窝局部放射治疗是乳腺癌治疗相关上肢淋巴水肿的危险因素

(OR=3.124,95%CI:1.927 ～5.064, P＜0.001; OR=2.017, 95%CI: 1.240 ～3.282, P=0.005; OR=2.512,95%CI:1.495 ～4.222, P=0.001)。 上肢负荷过重、外伤、感染是形成上肢淋巴水肿的诱因。

结论

上肢淋巴水肿是乳腺癌术后严重的并发症。 对于体质指数≥25、术中行腋窝淋巴结清扫以及术后行放射治疗的患者,在治疗中应予高度重视,以便及早干预,避免淋巴水肿发生。

Objective

To explore the occurrence of upper extremity lymphedema in breast cancer patients and risk factors.

Methods

We retrospectively analyzed the clinical data of 348 patients who were diagnosed with unilateral breast cancer and underwent modified radical mastectomy in Jingxi Branch of Beijing Chaoyang Hospital from January 2006 to March 2014. The upper extremity lymphedema was assessed in all patients: the circumferences of upper arm, forearm and wrist were detected; if the circumference in unaffected extremity was 2 cm longer than that of affected extremity, it was regarded as upper extremity lymphedema. The risk factors related to lymphedema were analyzed, including age, body mass index, T stage, axillary lymph node metastasis,axillary lymph node dissection,approach of breast resection and postoprative adjuvant therapy.χ² test was used for univariate analysis, Logistic regression for multivariate analysis.

Results

In 348 cases,88 cases (25.3%) were diagnosed with postoperative upper extremity lymphedema. The incidence of lymphedema was 25.3% (88/348) in 5 years after operation. Univariate analysis showed that in upper extremity lymphedema group, the rate of the patients with age ＞60 years, body mass index ≥25, axillary lymph node metastasis, metastatic lymph nodes≥4, axillary lymph node dissection and postoperative axillary radiotherapy was 31.1%(46/148),41.0%(43/105),40.4%(53/131),37.5%(33/88),40.6%(88/247)and 85.2%(23/27) respectively, significantly higher than 21%(42/42),18.5%(45/243),16.1%(35/217),21.2%(55/260),0(0/101) and 20.2%(65/321) in the patients without upper extremity lymphedema (χ²=4.575,19.531,25.592,15.886,48.163,55.585; all P values＜0.050). Multivariate analysis showed that body mass index,axillary lymph node dissection and postoperative loco-regional radiotherapy were risk factors of upper extremity lymphedema for breast cancer patients (OR=3.124,95%CI:1.927-5.064, P＜0.001; OR=2.017,95% CI: 1.240-3.282, P=0.005; OR= 2.512, 95% CI: 1.495-4.222, P = 0.001). Upper extremity overload,trauma and infection were the main causes of upper extremity lymphedema.

Conclusions

Upper extremity lymphedema is a serious postoperative complication in breast cancer patients. The physicians should pay more attention to the patients with body mass index ≥25, axillary lymph node dissection and postoperative radiotherapy in order to prevent lymphedema as early as possible.