乳腺癌术后手背部Ⅲ级淋巴水肿行多层绷带联合施耐德包扎效果探讨

目的 促进乳腺癌术后患侧手背部Ⅲ级淋巴水肿患者淋巴回流,减轻局部症状与病理改变。 方法 将来我院淋巴水肿门诊就诊的86例乳腺癌术后患侧上肢Ⅲ级淋巴水肿患者按就诊时间段分为常规组44例、改进组42例。常规组行常规多层绷带从指端到肩下加压包扎;改进组采用多层绷带联合施耐德包扎法。每天1次,连续20次后评价效果。 结果 改进组患侧手掌周径减小程度显著优于常规组（均P＜0.01）,紧绷感、麻木感、肿胀感发生率显著低于常规组（P＜0.05, P＜0.01）。 结论 多层绷带联合施耐德包扎法可有效促进淋巴回流,有利于恢复肢体形状,缓解主观症状。     

肢体慢性淋巴水肿CDT治疗后低弹力绷带使用时长对远期疗效的影响

目的 探讨肢体慢性淋巴水肿CDT(Complex decongestion therapy)治疗后低弹绷带使用时长对于长期疗效的影响。方法 2016至今,对57例淋巴水肿患者按治疗结束后自我使用低弹绷带包扎时长（t）分为A(>1年)、B(0.5～1年)、C(<0.5年)3组。采用多频生物电阻人体成分分析仪测量组织水分,卷尺测量肢体周径。比较3组患者复诊时与治疗结束时水分和周径的变化。结果 A组在维持肢体周径、水分方面明显优于B组和C组,B组则优于C组（P<0.05）。3组治疗后的丹毒发作频率均有改善,A组改善最为明显（P<0.05）。结论 肢体慢性淋巴水肿患者在CDT治疗结束后应继续使用低弹绷带包扎患肢,坚持使用越久的患者长期疗效越好。     

空气波压力治疗乳腺癌术后患者上肢淋巴水肿效果观察

目的探讨应用空气波压力治疗乳腺癌术后患者上肢淋巴水肿的治疗效果。方法对22例上肢淋巴水肿患者采用空气波压力治疗2个疗程。结果治疗后患者普遍反映肢体轻松，活动灵便，皮肤张力下降。治疗前后患肢4个测试点周径比较，差异有显著性意义（均P〈0．05）。结论空气波压力治疗乳腺癌术后上肢淋巴水肿，效果较好，操作简便，使用安全、无痛苦。     

空气波压力治疗乳腺癌术后患者上肢淋巴水肿效果观察

目的 探讨应用空气波压力治疗乳腺癌术后患者上肢淋巴水肿的治疗效果.方法 对22例上肢淋巴水肿患者采用空气波压力治疗2个疗程.结果 治疗后患者普遍反映肢体轻松,活动灵便,皮肤张力下降.治疗前后患肢4个测试点周径比较,差异有显著性意义(均P＜0.05).结论 空气波压力治疗乳腺癌术后上肢淋巴水肿,效果较好,操作简便,使用安全、无痛苦.     

乳腺癌手术后的淋巴水肿

重点介绍了乳腺癌手术后淋巴水肿的病因、病理生理以助于预防和减少其发生。     

手法淋巴引流治疗乳腺癌术后上肢淋巴水肿

目的 探讨运用手法淋巴引流(Manual Lymph Drainage,MLD)治疗乳腺癌术后上肢淋巴水肿的疗效。方法2008年至2012年,101例乳腺癌术后上肢淋巴水肿患者按治疗前患肢与健肢的周径(d)差值分3组:A组(d5 cm)。3组患者均进行1个疗程(15 d)的淋巴水肿综合消肿治疗(Complex Decongestive Therapy,CDT):手法淋巴引流+低弹性绷带包扎。通过检测引流前后健患侧的组织水分和肢体周径,计算水分比率与周径比率,同时调查患者对手法引流及绷带使用情况的主观感受,以观察并评价患者对治疗的适应性和接受度。组织水分采用多频生物电阻人体成分分析仪进行检测。结果 101例患者经CDT治疗后,患肢组织水分和肢体周径均呈显著下降(PB组>A组(P<0.01),即治疗效果与水肿严重程度成正比。几乎所有患者对治疗方法及效果表示满意。结论 CDT能有效促进乳腺癌术后上肢淋巴水肿的淋巴回流,减轻患肢水肿,改善患肢外形,帮助功能恢复,并且该治疗对水肿程度较重的患者疗效尤其显著。     

手法淋巴引流综合治疗肢体慢性淋巴水肿

目的 探讨采用手法淋巴引流治疗慢性淋巴水肿的新方法.方法 50例慢性肢体淋巴水肿患者接受了手法淋巴引流综合消肿治疗,对体表(包括躯干和肢体)淋巴系统沿淋巴回流方向和途径做轻柔的按压和按摩.50例中原发性淋巴水肿29例,继发性21例;下肢患病42例,上肢患病8例.采用多频生物电阻人体成分分析仪检测组织水肿和测量肢体周径检验治疗效果.结果 经过1～2个疗程的治疗,50例患病肢体的水肿均有不同程度的减轻,表现为患肢组织水肿程度显著减轻(P＜0.05)和患肢周径的显著缩小(P＜0.05).肢体周径与组织水肿变化的相关性检验表明两者有非常显著的相关性(rs=0.774,P＜0.01).结论 手法淋巴引流综合治疗的有效地促进滞留组织淋巴水肿的回流,减轻肢体的肿胀,改善患肢的外形,是治疗慢性淋巴水肿有效的治疗手段.     

妇科相关肿瘤术后下肢淋巴水肿合并会阴部水肿的综合治疗初探

目的 比较分析妇科肿瘤术后下肢淋巴水肿合并会阴部水肿患者采用不同方案治疗的临床效果。方法 2019年11月至2021年6月,接受治疗的妇科肿瘤术后下肢淋巴水肿合并会阴部水肿的患者32例,进行4周治疗。随机分成A、B、C、D组,每组8例。A组采用手法淋巴引流综合消肿治疗（Complex decongestive therapy,CDT）加压力短裤的方式进行治疗;B组采用间歇充气加压仪（Intermittent pneumatic compression,IPC）加压力短裤的方式进行治疗;C组采用CDT加IPC加压力短裤的方式进行治疗;D组采用CDT加IPC加压力短裤及会阴部绷带包扎的方式进行治疗。比较4组患者治疗前后下肢节段水分、下肢周径、腰围、会阴局部水肿程度和分级、阴唇的宽度,以及治疗前后患者的主观感觉。结果 D组患者治疗后肢体节段水分、腰围、阴唇的宽度、会阴水肿分级改善程度优于另外3组,与A、B组差异有统计学意义（P<0.05）,D组的各项指标优于C组。肢体周径、会阴局部水肿程度变化各指标组内比较治疗前后均下降（P<0.05）。C、D组患者主观感受明显优于A、B组（P&...     

早期徒手淋巴引流联合压力袖套预防乳腺癌相关淋巴水肿的效果

目的:观察乳腺癌改良根治术后实施早期干预措施降低乳腺癌相关淋巴水肿(BCRL)发生率、减轻相关症状、提高患者生命质量的效果。方法:纳入2021年12月至2022年8月符合条件的乳腺癌患者114例,随机分为3组,对照组实施常规护理,干预1组在对照组的基础上实施术后早期徒手淋巴引流(MLD),干预2组在干预1组的基础上增加压力袖套的使用。对比分析术后1个月、3个月BCRL发生率,术后3个月BCRL相关症状及生命质量,以评价干预效果。结果:术后1个月,3组BCRL发生率差异无统计学意义(P>0.05)。术后3个月,对照组BCRL发生率高于其他两组(P<0.05);对照组BCRL相关症状得分高于干预1组,干预1组高于干预2组,差异有统计学意义(P<0.001);对照组生命质量总分低于干预1组,干预1组低于干预2组,差异有统计学意义(P<0.05)。结论:乳腺癌术后早期进行徒手淋巴引流联合压力袖套干预可有效降低术后乳腺癌相关BCRL发生率,提高患者生命质量。     

乳腺癌相关淋巴水肿的危险因素及治疗进展

乳腺癌是女性最常见的恶性肿瘤,近年来,乳腺癌发病率的增长速度仅次于肺部恶性肿瘤,并且呈现逐渐年轻化的趋势,得益于治疗技术的发展及人们对于乳腺检查的重视、自身健康意识的提高,患者通常能得到及时治疗,但如何避免或治疗乳腺癌相关并发症仍未得到足够重视.淋巴水肿是乳腺癌治疗后最常见的并发症,一旦出现则很难治愈,会长期影响患者的...     

Early prevention of complex decongestive therapy and rehabilitation exercise for prevention of lower extremity lymphedema after operation of gynecologic cancer

ObjectiveTo investigate efficacy of early prevention of complex decongestive therapy and rehabilitation exercise for prevention of postoperative lower limb extremity lymphedema for patients with gynecologic cancer.Methods109 female patients were randomly divided into two groups, the control group who only received routine treatment and the CDT group who received both CDT and rehabilitation exercise. For rehabilitation exercise, patients received additional rehabilitation exercise strategy including professional education and full range exercise of hip joint. The incidence of lower extremity lymphedema was recorded. A simple scale for patients’ lower extremity lymphedema was designed. The diameter of low limbs (both thighs and calves) was also measured The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the Brief Fatigue Inventory (BFI) was used for measurement of quality of life.ResultsThe incidence of lower extremity lymphedema was 15.09% cases of CDT group and 32.14% in the control group. K-M curve showed the lymphedema free time in CDT group was significantly longer. The subjective scores for heaviness of lower limbs, pain, numbness and dysfunction, as well as the diameters of both thighs and calves were lower in the CDT group. In both groups, the values of EORTC QLQ-C30-GHS and EORTC QLQ-C30-FS were significantly higher, and EORTC QLQ-C30-SS scores and BFI scores were remarkably lower.ConclusionEarly prevention of CDT combined with rehabilitation exercise reduced incidence of lower limb extremity lymphedema and improved patients’ quality of life, as well as reduced the cancer-related fatigue.     

一种新型压力绷带在乳腺癌术后的应用价值

［摘要］ 目的 分析乳腺癌术后应用新型压力绷带的应用情况,探讨其在临床中的应用价值。方法 选取2016年10月~2018年10月间乳腺癌患者共200例,其中新型压力绷带与对照组（普通弹力绷带）各100例,比较患者术后的皮瓣坏死、皮下积液率、切口愈合、平均拔管时间、日引流量、平均住院日、术后舒适度。结果 新型压力绷带应用于乳腺癌术后患者可以减少皮瓣坏死及皮下积液、促进切口愈合（χ2=8.00、12.37、6.82,均P<0.01）,减少引流量、缩短拔管时间及平均住院日（t=17.59、26.52、30.25、9.97,均P<0.01）,使患者术后舒适度提高（χ2=18.52、8.72、8.79,均P<0.01）,差异均有统计学意义。结论 新型压力绷带应用于乳腺癌术后患者优于对照组（普通弹力绷带）,可取得满意的临床效果。     

Lymphaticovenular anastomosis improves quality of life and limb volume in patients with secondary lymphedema after breast cancer treatment

Secondary lymphedema is a common side effect of breast cancer treatment, with significant impact on patients' physical and psychological well‐being. Conservative therapies are the gold standard treatment, however surgical options are becoming more popular. Lymphaticovenular anastomosis (LVA) is a supermicrosurgical procedure that aims to restore lymphatic flow by anastomosing damaged lymphatics to subcutaneous venules. We aimed to assess the effects of LVA on patients' limb volume and quality of life. Pre‐ and postoperative limb volumes and LYMQOL scores were collected for patients undergoing LVA for lymphedema secondary to breast cancer. Thirty‐seven patients underwent LVA. A significant reduction was seen in median excess limb volume postoperatively (13.3%‐6.6%, P < 0.005), with volumetric improvement seen in 78% of patients. Thirteen patients were able to discontinue compression garment use. Eighty‐six percent of patients reported improved quality of life postoperatively with median LYMQOL score increasing from 90 to 104 points (P < 0.005). LVA is a minimally invasive surgical option for patients with early stage lymphedema. It can lead to significant volumetric improvements and in select patients, freedom from compression therapy. LVA can also lead to significant improvements in quality of life, in particular patients' mood and perception of their appearance.     

乳腺癌术后上肢淋巴水肿患者自我管理体验的质性研究

目的 了解乳腺癌术后上肢淋巴水肿患者自我管理中的体验和感受,为临床制订解决方案提供参考。方法 采用质性研究方法对15例乳腺癌术后上肢淋巴水肿患者进行半结构式访谈,采用Colaizzi7步分析法分析资料。结果 提炼出6个主题,包括缺乏自我管理知识、思想上未引起足够重视、管理方式的差异化、自我管理过程中存在诸多障碍、自我管理中的情绪问题和社会支持不足。结论 乳腺癌术后上肢淋巴水肿患者在自我管理过程中存在较多问题,医护人员应帮助患者纠正对疾病的错误认知及处理方式,树立良好的自我管理行为与习惯,重视患者由自我管理产生的心理问题,联合家庭和社会共同提高患者的自我管理能力。     

Problems with the use of breast conservation therapy for breast cancer in a patient with neurofibromatosis type 1: a case report

Abstract:  Patients with Neurofibromatosis type I and breast cancer represent a subset of people who may be considered at high risk for secondary cancers after conventional whole breast radiation therapy and breast conservation surgery. A case of a 49-year-old woman with neurofibromatosis type I is presented. She was diagnosed with a 1.1-cm right breast infiltrating ductal carcinoma. Clinical, diagnostic imaging, and pathologic features are discussed. Her initial treatment plan of breast conserving therapy was thwarted when her sentinel node biopsy was positive for micrometastatic disease in 1/14 lymph nodes. She elected to have a bilateral simple mastectomy. This case addresses the rare dilemma of offering breast conservation therapy as a viable option for patients with neurofibromatosis type I. Current data on radiation-induced secondary cancers such as sarcoma after treatment for breast and other cancers are reviewed.     

Synchronous male breast cancer and carcinoma of prostate in 90-year-old male, presented with spinal cord compression and multiple spine lytic lesions

Male breast cancer and prostate cancer are similar in many ways, including the potential role of steroid hormones in their pathogenesis. We describe a 90-year-old male patient, who came with synchronous male breast cancer and carcinoma of the prostate. The first presentation was spinal cord compression with multiple lytic lesions in the thoracic and lumbar vertebrae on computed tomography. Serum tumor marker tests revealed an elevated serum PSA level of 104 ng/dL (normal <4 ng/dL) and a low free PSA of 11.6%. A histological examination of a specimen from a lytic lesion of the spine was consistent with metastatic breast cancer and a needle biopsy of the prostate showed adenocarcinoma, Gleason score 3 + 4.     

Age <40Years is an independent prognostic factor predicting inferior overall survival in patients treated with breast conservative therapy

To evaluate the effect of age at diagnosis on the treatment outcome after breast conservative therapy (BCT), retrospective analysis was done for 378 patients undergoing BCT for early breast cancer. Patients were divided into two groups according to their age: 'younger' (<40years, n=108) and 'older' (≥40years, n=270). Multivariate analysis was performed on the variables including tumor characteristics, the use of systemic therapy, and age to assess risk factors for local-regional relapse-free survival (LRRFS), distant metastasis-free survival (DMFS), and overall survival rates (OS). The median follow-up duration was 94months. The 8-year LRRFS, DMFS, and OS for younger and older groups were 88.1% and 96.5% (p=0.0022); 85.7% and 93.7% (p=0.0310); 89.2% and 95.9% (p=0.0205), respectively. On multivariate analysis, younger age was the only significant predictor of poor LRRFS (p=0.0022). Younger age and ER negativity showed borderline significance for DMFS (p=0.0828 and 0.0618, respectively). Younger age had trend toward inferior OS (p=0.0702). In conclusion, age younger than 40years was associated with inferior LRRFS in early breast cancer patients treated with BCT. There was also a trend for inferior DMFS and OS in younger patients. Age at diagnosis should be considered for individualized patient management.     

保乳手术治疗BRCA1/2基因突变型乳腺癌的可行性

保乳手术作为乳腺肿瘤外科一种重要的手术方式,对于其是否适用于BRCA1/2基因突变型乳腺癌患者,目前仍存在争议.由于家族性乳腺癌患者仍然具有单侧多发和对侧发病的高风险,对BRCA1/2基因突变型乳腺癌患者不推荐实施保乳手术,推荐行乳腺全切术和/或Ⅰ期乳房成形手术.但如果BRCA 1/2基因突变型乳腺癌患者有强烈的保乳意愿,在充分告知可能存在风险的前提下,保乳手术也是可行的,但是应考虑双侧卵巢切除或他莫昔芬治疗,同时需要进行更多的干预措施预防对侧乳腺发病.