乳腺癌术后上肢淋巴水肿的危险因素分析

  目的 分析接受腋窝淋巴结清扫的乳腺癌患者术后上肢淋巴水肿的发生情况，并探讨与水肿发生相关的危险因素。方法 回顾分析261例沈阳市乳腺癌患者的临床资料，统计可能与术后上肢淋巴水肿发生相关的13个因素：发病年龄、体质指数、肿瘤大小、临床分期、前哨淋巴结活检、腋窝清扫范围、淋巴结病理分期、腋窝淋巴结清扫数量、放疗、化疗、内分泌治疗、优势侧上肢、术后愈合并发症，对所得数据采用SPSS13. 0软件进行Logistic回归分析。结果 全组261例患者中52例（19.9%）术后发生了上肢淋巴水肿，其中轻度水肿26例（50.0%），中度水肿19例（36.5%），重度水肿7例（13.5%）。与术后上肢淋巴水肿发生有关的危险因素有5项，分别为年龄（OR=3.196）、体质指数（OR=2.211）、腋窝清扫范围（OR=3.582）、放疗（OR=3.689）和伤口愈合并发症（OR=3.263）。结论 术后放疗、腋窝清扫范围、术后愈合并发症（包括延迟愈合、感染、积液等）、年龄、体质指数为接受腋窝淋巴结清扫的乳腺癌患者术后发生上肢淋巴水肿的独立危险因素。

Analysis on Risk Factors for Arm Lymphedema Following Breast Cancer Surgery

Objective To analyze the incidence of arm lymphedema and identify the risk factors for arm lymphedema in breast cancer patients underwent ALND(axillary lymphnode dissection).Methods The clinical data were collected from 261 breast cancer patients who received axillary lymphnode dissection in our hospital between January 2008 and December 2009.The main thirteen factors that may cause arm lymphedema following the surgery were investigated,including age,body mass index(BMI),tumor size,clinical stage of tumor,SLNB(sentinel lymph node biopsy),extent of axillary surgery,pN-stage,number of lymph nodes excised,radiotherapy,chemotherapy,hormone therapy,other complication(late healed/infection/effusion of the wound),dominant hand.The statistics were analyzed with logistic regression(SPSS version 13.0).Results Among the 261 cases,19.9%(n =52) had developed lymphedema,of which 50.0%(n =26) had mild lymphedema,36.5%(n =19) had moderate lymphedema,13.5%(n =7) had severe lymphedema.Five factors were related to arm lymphedema following ALND for breast cancer:age(OR =3.196),BMI(OR =2.211),extent of axillary surgery(OR =3.582),radiotherapy(OR =3.689),and postoperative complications(OR =3.263).Conclusion Radiotherapy,extent of axillary surgery,postoperative complications,age,and BMI are the independent risk factors for arm lymphedema in breast cancer patients underwent ALND.