切换至 "中华医学电子期刊资源库"
高级检索
中华乳腺病杂志(电子版)

中华乳腺病杂志(电子版) ›› 2020, Vol. 14 ›› Issue (03) : 141 -144. doi: 10.3877/cma.j.issn.1674-0807.2020.03.003

所属专题： 文献；

论著

乳腺癌术后上肢淋巴水肿的危险因素分析
林武华1,†(), 陈茜1, 周琦1   
  1. 1. 614000　四川　乐山，武警四川省总队医院乳腺外科
  • 收稿日期:2020-02-06 出版日期:2020-06-01
  • 通信作者: 林武华
  • 基金资助:
    乐山市2019年重点科技计划资助项目(19SZD190)

Risk factors of upper extremity lymphedema after breast cancer surgery

Wuhua Lin1,†(), Qian Chen1, Qi Zhou1   

  1. 1. Department of Breast Surgery, Sichuan Provincial Hospital of Armed Police Force, Leshan 614000, China
  • Received:2020-02-06 Published:2020-06-01
  • Corresponding author: Wuhua Lin
  • About author:
    Corresponding author: Lin Wuhua, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

林武华, 陈茜, 周琦. 乳腺癌术后上肢淋巴水肿的危险因素分析[J/OL]. 中华乳腺病杂志(电子版), 2020, 14(03): 141-144.

Wuhua Lin, Qian Chen, Qi Zhou. Risk factors of upper extremity lymphedema after breast cancer surgery[J/OL]. Chinese Journal of Breast Disease(Electronic Edition), 2020, 14(03): 141-144.

目的

探讨乳腺癌术后患者发生上肢淋巴水肿的危险因素。

方法

回顾性分析2014年1月至2016年6月在武警四川省总队医院接受保留乳房手术或改良根治术的305例乳腺癌患者的临床资料。所有患者均接受腋窝淋巴结清扫。通过臂围测量的方法，诊断患者的上肢淋巴水肿情况。从术后1个月开始由患者自测臂围，每月2次，再通过门诊或电话随访收集患者双上肢臂围数据。所有患者随访时间为1～36个月，中位随访时间为27个月。随访截止日期为2019年6月30日。采用χ2检验或非参数检验(Kruskal-Wallis H检验)比较上肢淋巴水肿患者和非上肢淋巴水肿患者的临床病理特征，采用非条件Logistic回归分析上肢淋巴水肿的危险因素。

结果

在随访期内，18例发生同侧上肢淋巴水肿(上肢淋巴水肿组)，287例未发生上肢淋巴水肿(非上肢淋巴水肿组)，术后上肢淋巴水肿的发生率是5.9%(18/305)。上肢淋巴水肿组和非上肢淋巴水肿组患者在腋窝淋巴结清扫、腋窝放射治疗、BMI、糖尿病方面比较，差异均有统计学意义(Z＝－3.532，P<0.001；χ2＝66.391、4.935、8.196，P均<0.050)。Logistic回归分析结果显示，Ⅲ水平腋窝淋巴结清扫、腋窝放射治疗、BMI≥25和糖尿病是乳腺癌患者术后上肢淋巴水肿的危险因素(OR＝4.661，95%CI：1.359～15.990, P＝0.014；OR＝3.548，95%CI：1.311～9.794, P＝0.013；OR＝4.580，95%CI：1.795～11.628, P＝0.001；OR＝4.404，95%CI：1.663～11.660, P＝0.003)。

结论

接受Ⅲ水平腋窝淋巴结清扫及腋窝放射治疗、BMI≥25及糖尿病的患者发生术后上肢淋巴水肿的风险较高，应尽早干预，积极预防。

关键词: 淋巴水肿, 乳腺肿瘤, 放射治疗, 危险因素
Objective

To explore the risk factors of upper extremity lymphedema in breast cancer patients after surgery.

Methods

A retrospective study was conducted to analyze the clinical data of 305 breast cancer patients who underwent breast-conserving surgery or modified radical mastectomy in the Sichuan Provincial Hospital of Armed Police Force from January 2014 to June 2016. All patients received axillary lymph node dissection. The upper extremity lymphedema was diagnosed by arm circumference measurement. The arm circumference was measured by patients one month after surgery, twice per month. The data were collected in clinic or by telephone in the follow-up. All patients were followed up for 1 to 36 months(median 27 months) until June 30, 2019. χ2 test or nonparametric test (Kruskal-Wallis H test) was used to compare the clinicopathological characteristics of patients with or without upper extremity lymphedema. Unconditional logistic regression was used to analyze the risk factors of upper extremity lymphedema.

Results

During the follow-up, 18 cases had ipsilateral upper extremity lymphedema (upper extremity lymphedema group) and 287 cases had no upper extremity lymphedema (non-upper extremity lymphedema group). The incidence of postoperative upper extremity lymphedema was 5.9% (18/305). There was a significant difference in axillary lymph node dissection, axillary radiotherapy, BMI and diabetes between the upper extremity lymphedema group and the non-upper extremity lymphedema group(Z=-3.532, P<0.001; χ2=66.391, 4.935, 8.196, all P<0.050). Logistic regression analysis showed that level Ⅲ axillary lymph node dissection, axillary radiotherapy, BMI≥25 and diabetes were risk factors of postoperative upper extremity lymphedema in breast cancer patients(OR=4.661, 95%CI: 1.359-15.990, P=0.014; OR=3.548, 95%CI: 1.311-9.794, P=0.013; OR=4.580, 95%CI: 1.795-11.628, P=0.001; OR=4.404, 95%CI: 1.663-11.660, P=0.003).

Conclusion

The patients with level Ⅲ axillary lymph node dissection and axillary radiotherapy, BMI ≥25 and diabetes are in high risk of postoperative upper extremity lymphedema, so early intervention should be given for prevention.

Key words: Lymphedema, Breast neoplasms, Radiotherapy, Risk factors
表1 305例乳腺癌患者术后上肢淋巴水肿Logistic回归分析变量赋值表
变量 变量名 变量赋值
生活环境 X1 城市＝0；农村＝1
TNM分期 X2 Ⅰ期＝0；Ⅱ期＝1；Ⅲ期＝2
腋窝淋巴结清扫 X3 Ⅰ水平＝0；Ⅱ水平＝1；Ⅲ水平＝2
腋窝淋巴结转移 X4 否＝0；是＝1
手术方式 X5 保留乳房手术＝0；改良根治术＝1
腋窝放射治疗 X6 否＝0；是＝1
化疗 X7 否＝0；是＝1
内分泌治疗 X8 否＝0；是＝1
体质指数 X9 <25＝0；≥25＝1
糖尿病 X10 否＝0；是＝1
高血压 X11 否＝0；是＝1
上肢淋巴水肿 Y 否＝0；是＝1
表2 上肢淋巴水肿组与非上肢淋巴水肿组乳腺癌患者的临床病理特征比较(例)
组别 例数 生活环境 TNM分期 腋窝淋巴结清扫
城市 农村 Ⅰ Ⅱ Ⅲ Ⅰ水平 Ⅱ水平 Ⅲ水平
上肢淋巴水肿组 18 12 6 1 8 9 3 6 9
非上肢淋巴水肿组 287 198 89 14 134 139 145 97 45
检验值 ? χ2＝0.043 Z＝－0.092 Z＝－3.532
P值 ? 0.836 0.927 <0.001
组别 例数 腋窝淋巴结转移 手术方式 腋窝放射治疗
是 否 改良根治术 保留乳房手术 是 否
上肢淋巴水肿 18 12 6 13 5 14 4
非上肢淋巴水肿 287 231 56 223 64 25 262
检验值 ? χ2＝1.998 χ2＝0.290 χ2＝66.391
P值 ? 0.158 0.590 <0.001
组别 例数 化疗 内分泌治疗 体质指数 糖尿病 高血压
是 否 是 否 ≥25 <25 是 否 是 否
上肢淋巴水肿 18 16 2 13 5 10 8 10 8 6 12
非上肢淋巴水肿 287 249 38 231 56 231 56 65 222 53 234
检验值 ? χ2＝0.067 χ2＝0.723 χ2＝4.935 χ2＝8.196 χ2＝2.339
P值 ? 0.795 0.395 0.026 0.004 0.121
表3 305例乳腺癌患者术后发生上肢淋巴水肿的Logistic回归分析结果
变量 B值 标准误 Wald值 P值 OR值 95%置信区间
腋窝淋巴结清扫 ? ? ? ? ? ?
? Ⅱ水平 1.056 0.588 3.225 0.073 2.876 0.908～9.107
? Ⅲ水平 1.539 0.629 5.991 0.014 4.661 1.359～15.990
腋窝放射治疗 1.276 0.513 6.192 0.013 3.548 1.311～9.794
体质指数 1.522 0.478 10.143 0.001 4.580 1.795～11.682
糖尿病 1.483 0.497 8.906 0.003 4.404 1.663～11.660
[1]
Ozaslan C, Kuru B. Lymphedema after treatment of breast cancer[J]. Am J Surg, 2004, 187(1): 69-72.
[2]
Ferlay J, Colombet M, Soerjomataram I, et al. Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods[J]. Int J Cancer, 2019, 144(8): 1941-1953.
[3]
McLaughlin SA, Wright MJ, Morris KT, et al. Prevalence of lymphedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection: objective measurements[J]. J Clin Oncol, 2008，26(32): 5213-5219.
[4]
National Health Commission of the People’s Republic of China. Chinese guidelines for diagnosis and treatment of breast cancer 2018(English version)[J]. Chin J Cancer Res, 2019, 31(2): 259-277.
[5]
Larson D, Weinstein M, Goldberg I, et al. Edema of the arm as a function of the extent of axillary surgery in patients with stage Ⅰ-Ⅱ carcinoma of the breast treated with primary radiotherapy[J]. Int J Radiat Oncol Biol Phys, 1986, 12(9): 1575-1582.
[6]
Herd-Smith A, Russo A, Muraca MG, et al. Prognostic factors for lymphedema after primary treatment of breast carcinoma[J]. Cancer, 2001，92(7): 1783-1787.
[7]
Fajardo LF. Effects of ionizing radiation on lymph nodes[J]. Front Radiat Ther Oncol, 1994, 28: 37-45.
[8]
Shah C, Vicini FA. Breast cancer-related arm lymphedema: incidence rates, diagnostic techniques, optimal management and risk reduction strategies[J]. Int J Radiat Oncol Biol Phys, 2011, 81(4): 907-914.
[9]
Kiel KD, Rademacker AW. Early-stage breast cancer: arm edema after wide excision and breast irradiation[J]. Radiology, 1996，198(1): 279-283.
[10]
Edwards TL. Prevalence and etiology of lymphedema after breast cancer treatment in Southern Tasmania[J]. Aust NZ J Surg, 2000, 70(6): 412-418.
[11]
Roses DF, Brooks AD, Harris MN, et al. Complications of level Ⅰ and Ⅱ axillary dissection in the treatment of carcinoma of the breast[J]. Ann Surg, 1999, 230(2): 194-201.
[12]
Zhu YQ, Xie YH, Liu FH, et al. Systemic analysis on risk factors for breast cancer related lymphedema[J]. Asian Pac J Cancer Prev, 2014, 15(16): 6535-6541.
[13]
Moffat FL, Senofsky GM, David K, et al. Axillary node dissection for early breast cancer: some is good, but all is better[J]. J Surg Oncol, 1992，51(1): 8-13.
[14]
Ragaz J, Jackson SM, Le N, et al. Adjuvant radiotherapy and chemotherapy in node positive premenopausal women with breast cancer[J]. N Engl J Med, 1997, 337(14): 956-962.
[15]
Felmerer G, Sattler T, Lohrmann C, et al. Treatment of various secondary lymphedemas by microsurgical lymph vessel transplantation[J]. Microsurgery, 2012，32(3): 171-177.
[1] 史学兵, 谢迎东, 谢霓, 徐超丽, 杨斌, 孙帼. 声辐射力弹性成像对不可切除肝细胞癌门静脉癌栓患者放射治疗效果的评价[J/OL]. 中华医学超声杂志（电子版）, 2024, 21(08): 778-784.
[2] 李洋, 蔡金玉, 党晓智, 常婉英, 巨艳, 高毅, 宋宏萍. 基于深度学习的乳腺超声应变弹性图像生成模型的应用研究[J/OL]. 中华医学超声杂志（电子版）, 2024, 21(06): 563-570.
[3] 河北省抗癌协会乳腺癌专业委员会护理协作组. 乳腺癌中心静脉通路护理管理专家共识[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(06): 321-329.
[4] 刘晨鹭, 刘洁, 张帆, 严彩英, 陈倩, 陈双庆. 增强MRI 影像组学特征生境分析在预测乳腺癌HER-2 表达状态中的应用[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(06): 339-345.
[5] 张晓宇, 殷雨来, 张银旭. 阿帕替尼联合新辅助化疗对三阴性乳腺癌的疗效及预后分析[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(06): 346-352.
[6] 邱琳, 刘锦辉, 组木热提·吐尔洪, 马悦心, 冷晓玲. 超声影像组学对致密型乳腺背景中非肿块型乳腺癌的诊断价值[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(06): 353-360.
[7] 程燕妮, 樊菁, 肖瑶, 舒瑞, 明昊, 党晓智, 宋宏萍. 乳腺组织定位标记夹的应用与进展[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(06): 361-365.
[8] 涂盛楠, 胡芬, 张娟, 蔡海峰, 杨俊泉. 天然植物提取物在乳腺癌治疗中的应用[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(06): 366-370.
[9] 朱文婷, 顾鹏, 孙星. 非酒精性脂肪性肝病对乳腺癌发生发展及治疗的影响[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(06): 371-375.
[10] 韩萌萌, 冯雪园, 马宁. 乳腺癌改良根治术后桡神经损伤1例[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 117-118.
[11] 高杰红, 黎平平, 齐婧, 代引海. ETFA和CD34在乳腺癌中的表达及与临床病理参数和预后的关系研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 64-67.
[12] 贺斌, 马晋峰. 胃癌脾门淋巴结转移危险因素[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 694-699.
[13] 张志兆, 王睿, 郜苹苹, 王成方, 王成, 齐晓伟. DNMT3B与乳腺癌预后的关系及其生物学机制[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 624-629.
[14] 王玲艳, 高春晖, 冯雪园, 崔鑫淼, 刘欢, 赵文明, 张金库. 循环肿瘤细胞在乳腺癌新辅助及术后辅助治疗中的应用[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 630-633.
[15] 颜世锐, 熊辉. 感染性心内膜炎合并急性肾损伤患者的危险因素探索及死亡风险预测[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 618-624.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号