Fulford Dean, Dalal Sam, Winstanley John, Hayton Mike J
Department of Orthopaedics, Royal Bolton Hospital, Farnworth, UK.
Ann R Coll Surg Engl. 2010 Oct;92(7):573-6. doi: 10.1308/003588410X12699663904475. Epub 2010 Jun 28.
Breast cancer patients who have had prior axillary lymph node clearance (ALNC) can present with ipsilateral hand conditions that could easily be treated with surgical intervention. These patients are often advised to avoid interventional procedures due to risks of complications such as lymphoedema, infection and cellulitis.
Between April and June 2009, we conducted an online survey of hand surgeons, breast surgeons and breast-care nurses to obtain their views on hand surgery after ipsilateral axillary lymph node clearance.
The majority of hand surgeons (58%) felt there was no contra-indication to surgery in a breast cancer patient with prior ipsilateral ALNC compared to just 30% of breast surgeons and 10% of breast-care nurses. The majority of breast surgeons and breast-care nurses (70% and 89%, respectively) felt that hand surgery was a relative contra-indication compared to just 41% of hand surgeons. Postoperative lymphoedema was the commonest cited reason for avoiding surgery. The majority of hand surgeons (79%) and nearly two-thirds of breast surgeons (57%) would use a tourniquet during surgery if it was normal practice.
A review of the published literature does not support the notion that these patients experience increased complications; therefore, we recommend the advice given to breast cancer patients regarding ipsilateral surgery be re-evaluated.
曾接受过腋窝淋巴结清扫术（ALNC）的乳腺癌患者可能会出现同侧手部疾病，这些疾病通过手术干预很容易得到治疗。由于存在诸如淋巴水肿、感染和蜂窝织炎等并发症风险，这些患者通常被建议避免进行介入手术。
2009年4月至6月期间，我们对手外科医生、乳腺外科医生和乳腺护理护士进行了一项在线调查，以了解他们对同侧腋窝淋巴结清扫术后手部手术的看法。
大多数手外科医生（58%）认为，与仅30%的乳腺外科医生和10%的乳腺护理护士相比，既往有同侧腋窝淋巴结清扫术的乳腺癌患者进行手术没有禁忌证。大多数乳腺外科医生和乳腺护理护士（分别为70%和89%）认为手部手术是相对禁忌证，而手外科医生中只有41%持此观点。术后淋巴水肿是最常被提及的避免手术的原因。如果手术常规使用止血带，大多数手外科医生（79%）和近三分之二的乳腺外科医生（57%）会在手术中使用。
对已发表文献的回顾并不支持这些患者并发症增加的观点；因此，我们建议重新评估给予乳腺癌患者关于同侧手术的建议。
