目的

探讨乳腺癌腋窝淋巴结清扫术后上肢淋巴水肿相关症状,为淋巴水肿的早期诊断和症状管理提供指导。

方法

根据纳入和排除标准,回顾性选取2010年3 月至2015年12 月在皖南医学院第一附属医院甲乳外科就诊的乳腺癌腋窝淋巴结清扫术后的343 例患者为研究对象,采用自编的上肢淋巴水肿症状评估表对其进行调查。 采用上肢周径测量法作为淋巴水肿的诊断标准。 根据是否发生淋巴水肿把研究对象分为淋巴水肿组和非淋巴水肿组,采用χ² 检验、t 检验、非参数检验比较2 组患者一般资料、上肢淋巴水肿相关症状的发生率有无差异;采用χ² 检验比较上肢淋巴水肿及其相关症状的发生率在术后不同时间段(≤3 个月、＞3 ～6 个月、＞6 ～12 个月、＞12 ～24 个月、＞24 ～36 个月、＞36 个月)之间的差异。

结果

343 例乳腺癌患者中,84 例(24.5%)发生上肢淋巴水肿,非淋巴水肿患者259 例(75.5%)。 淋巴水肿组和非淋巴水肿组一般资料的比较中,患者临床分期和腋窝淋巴结清扫的级别差异有统计学意义(Z=-2.208,P=0.027; Z=-4.477,P=0.001)。 术后不同时间段患者淋巴水肿发生率的比较差异有统计学意义(χ²=21.405,P＜0.001),其中＞12 ～24 个月(39.0%,23/59)和＞24 ～36 个月(38.9%,14/36)患者淋巴水肿发生率显著高于≤3 个月(12.33%,9/73)(χ² =12.622, P＜0.001;χ²=10.216, P=0.001)。 在上肢淋巴水肿相关症状的比较中,上肢的沉重感[59.5%(50/84)比19.3%(50/259)]和肿胀感[56.0%(47/84)比19.3%(50/259)],在2 组间的差异有统计学意义(χ²=49.674、42.000,P 均＜0.001)。 上肢沉重感和肿胀感的发生率在术后不同时间段之间比较,差异无统计学意义(χ²=6.975,P=0.223;χ²=5.202,P=0.392)。

结论

上肢的沉重感和肿胀感作为上肢淋巴水肿相关症状,可为淋巴水肿早期诊断和筛查提供参考。

Objective

To explore the related symptoms of upper extremity lymphedema in breast cancer patients who underwent axillary lymph node dissection, and provide references for early diagnosis and management of lymphedema.

Methods

According to the inclusion and exclusion criteria, we enrolled 343 patients who underwent axillary lymph node dissection in Department of Thyroid and Breast Surgery, First Affiliated Hospital of Wannan Medical College from March 2010 to December 2015. A self-designed questionnaire was used to investigate the lymphedema related symptoms of breast cancer patients. Lymphedema was defined by circumferential measurement and then all patients were divided into lymphedema group and nonlymphedema group. The general data and the incidence of upper extremity lymphedema between two groups were compared by χ² test, t test and nonparametric test. The incidences of upper extremity lymphedema in different periods after surgery (≤3 months, ＞3-6 months, ＞6-12 months, ＞12-24 months, ＞24-36 months, ＞36 months) were compared using χ² test.

Results

In 343 patients,84 patients (24.5%) were diagnosed with lymphedema and 259 (75.5%) presented no lymphedema. There were significant differences in clinical stage and axillary lymph node status between lymphedema group and non-lymphedema group (Z=-2.208, P=0.027; Z=-4.477, P=0.001). The incidence of upper extremity lymphedema in different postoperative periods showed a significant difference (χ² = 21.405, P ＜0.001). The incidence of upper extremity lymphedema was 39.0% (23/59) in postoperative 12 - 24 months and 38.9% (14/36) in postoperative 24-36 months, significantly higher than 12.3% (9/73)within postoperative 3 months(χ² =12.622, P＜0.001;χ² = 10.216, P = 0.001). The incidences of heaviness[59.5% (50/84) vs 19.3%(50/259)] and swelling[56.0%(47/84) vs 19.3%(50/259)] in upper extremities showed a significant difference between two groups (χ²=49.674,42.000, both P＜0.001). There was no significant difference in the incidences of heaviness and swelling of upper extremities among different periods after surgery(χ²=6.975,P=0.223;χ² = 5.202,P = 0.392).

Conclusion

The heaviness and swelling in upper extremities are lymphedema related symptoms, which can provide references for early diagnosis and management of lymphedema.