Mellor Russell H, Bush Nigel L, Stanton Anthony W B, Bamber Jeff C, Levick J Rodney, Mortimer Peter S
Department of Cardiac and Vascular Sciences (Dermatology Unit), St. George's Hospital Medical School, Cranmer Terrace, London, SW17 0RE, UK.
Breast J. 2004 Nov-Dec;10(6):496-503. doi: 10.1111/j.1075-122X.2004.21458.x.
Breast cancer-related lymphedema (BCRL) is a chronic swelling of the arm that sometimes follows breast cancer treatment. Clinically, both skin and subcutis are swollen. Edema is considered to be predominantly subcutaneous and of an even distribution. The purpose of this study was to quantify the degree and uniformity of skin and subcutis swelling around the forearms of women with BCRL. Ten women with BCRL were recruited. Both forearms were examined using 20 MHz ultrasound to visualize the skin and 7 MHz ultrasound to visualize the subcutis. Skin thickness was between the bottom of the entry-echo and the skin-subcutis boundary. Subcutis thickness was measured between the skin-subcutis boundary and the subcutis-muscle boundary. Both average skin thickness (1.97 +/- 1.00 mm) and average subcutis thickness (10.32 +/- 5.63 mm) were greater in the ipsilateral arm than in the contralateral arm (skin 1.12 +/- 0.14 mm, subcutis 5.58 +/- 2.04 mm, p < 0.01, t-test). The degree of increase in skin thickness did not vary around the arm (p > 0.05, ANOVA), while the degree of increase in subcutis thickness did vary (p < 0.05). Skin thickness correlated negatively with subcutis thickness in the contralateral arm, but correlated positively in the ipsilateral arm. The skin and subcutis are thickened in the ipsilateral arm of patients with BCRL. Skin thickness is increased uniformly around the arm and correlates strongly with the degree of swelling, while subcutis swelling varies. The measurement of skin thickness using ultrasound may form a useful clinical tool in the diagnosis of lymphedema and also aid further investigation of therapeutic techniques.
乳腺癌相关淋巴水肿（BCRL）是一种有时在乳腺癌治疗后出现的手臂慢性肿胀。临床上，皮肤和皮下组织均会肿胀。水肿被认为主要是皮下性的且分布均匀。本研究的目的是量化BCRL女性患者前臂周围皮肤和皮下组织肿胀的程度及均匀性。招募了10名BCRL女性患者。使用20兆赫超声检查双侧前臂以观察皮肤，使用7兆赫超声检查以观察皮下组织。皮肤厚度是在入射回声底部与皮肤 - 皮下组织边界之间测量。皮下组织厚度是在皮肤 - 皮下组织边界与皮下组织 - 肌肉边界之间测量。患侧手臂的平均皮肤厚度（1.97±1.00毫米）和平均皮下组织厚度（10.32±5.63毫米）均大于对侧手臂（皮肤1.12±0.14毫米，皮下组织5.58±2.04毫米，p<0.01，t检验）。手臂周围皮肤厚度增加的程度没有变化（p>0.05，方差分析），而皮下组织厚度增加的程度有变化（p<0.05）。对侧手臂的皮肤厚度与皮下组织厚度呈负相关，但患侧手臂呈正相关。BCRL患者患侧手臂的皮肤和皮下组织增厚。手臂周围皮肤厚度均匀增加且与肿胀程度密切相关，而皮下组织肿胀情况有所不同。使用超声测量皮肤厚度可能成为诊断淋巴水肿的一种有用临床工具，也有助于对治疗技术的进一步研究。
