中国普外基础与临床杂志

中国普外基础与临床杂志

气压泵联合微波治疗对乳腺癌改良根治术后上肢淋巴水肿的预防效果

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目的 探讨早期物理治疗对乳腺癌改良根治术后上肢淋巴水肿的预防效果。 方法 采用随机对照研究方法,前瞻性收集 2014 年 6 月至 2016 年 6 月期间于笔者所在医院接受乳腺癌改良根治术的 206 例患者为研究对象,随机均分为干预组和对照组。对照组患者术后接受常规预防方法处理,干预组患者除常规接受预防方法外,于术后第 2 天开始使用空气压力泵联合微波理疗仪进行预防性物理治疗。比较 2 组患者术后 6 个月和术后1 年时的上肢淋巴水肿发生率的差异,并探讨上肢淋巴水肿的影响因素。 结果 最终干预组有 99 例患者纳入分析,对照组有 96 例患者纳入分析。① 2 组患者术后 6 个月及术后 1 年时的上肢淋巴水肿发生率比较差异均存在统计学意义(P<0.05),术后 6 个月[2.0%(2/99)比 9.4%(9/96)]和术后 1 年时[5.1%(5/99)比 17.7%(17/96)],干预组的上肢淋巴水肿发生率均低于对照组。② 多因素 logistic 回归分析结果表明,年龄(OR=1.45,P=0.008)、肿瘤位置(OR=1.72,P<0.001)、TNM 分期(OR=2.01,P=0.033)、腋窝阳性淋巴结数量(OR=1.15,P=0.005)及术后放疗(OR=1.23,P=0.016)均是乳腺癌根治术后发生上肢淋巴水肿的影响因素,年龄>60 岁,肿瘤位于外上及外下象限,TNM 分期为Ⅲ期、腋窝阳性淋巴结数量>5 枚以及术后接受放疗者的上肢淋巴水肿发生率较高。 结论 乳腺癌改良根治术后尽早对患者进行物理治疗可有效预防术后上肢淋巴水肿的发生,对于具有上肢淋巴水肿高危发病因素的患者应该尽早进行预防性物理治疗。

Objective To explore the preventive effectiveness of early physiotherapy on arm lymphedema after modified radical mastectomy for breast cancer. Methods A total of 206 patients who underwent modified radical mastectomy for breast cancer in The First Affiliated Hospital of Henan University from June 2014 to June 2016, enrolled in this randomized controlled clinical trial. Then these patients were randomly divided into intervention group and control group equally. Patients in the control group received routine treatment, and the patients in the intervention group began to use the air pressure pump combined with the microwave physiotherapy on the second day after the radical surgery. The incidences of limb lymphedema in 6 months and 1 year after operation between the 2 groups were compared, and the influencing factors of arm lymphedema were explored. Results The clinical data of 195 patients were analyzed at end, including 99 patients of the intervention group and 96 patients of the control group. ① There were statistical significance in the incidences of arm lymphedema in 6 months and 1 year after operation between the 2 groups (P<0.05), that incidences of arm lymphedema in the intervention group were both lower than those of the control group at the2 time points [6 months after operation: 2.0% (2/99)vs. 9.4% (9/96); 1 year after operation: 5.1% (5/99) vs. 17.7% (17/96)]. ② The results of non-conditional logistic regression analysis shown that, age (OR=1.45, P=0.008), tumor location (OR=1.72, P<0.001), TNM stage (OR=2.01, P=0.033), the number of invasive axillary lymph nodes (OR=1.15, P=0.005), and postoperative radiotherapy (OR=1.23, P=0.016) were the influencing factors of arm lymphedema after modified radical mastectomy for breast cancer, patients with age older than 60 years, tumor position at the outside area, stage Ⅲ of TNM, the number of invasive axillary lymph nodes >5, and patients received radiotherapy after operation had high risk of arm lymphedema. Conclusion Early physiotherapy can effectively prevent the occurrence of arm lymphedema after modified radical mastectomy for breast cancer, and early physiotherapy should be performed for patients with high risk of arm lymphedema.

关键词: 上肢淋巴水肿; 物理治疗; 早期干预; 乳腺癌改良根治术

Key words: arm lymphedema; physiotherapy; early intervention; modified radical mastectomy for breast cancer

引用本文: 马志强, 范军朝, 王文胜, 师丙帅, 赵爱国, 张筱扬, 张双林. 气压泵联合微波治疗对乳腺癌改良根治术后上肢淋巴水肿的预防效果. 中国普外基础与临床杂志, 2018, 25(2): 191-196. doi: 10.7507/1007-9424.201708044 复制

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