Department of Physical Therapy and Oncology, University of Alberta and Cross Cancer Institute, Edmonton, Alberta, Canada.
Cancer. 2012 Apr 15;118(8 Suppl):2226-36. doi: 10.1002/cncr.27468.
Appropriate and timely rehabilitation is vital in the recovery from breast cancer surgeries, including breast conserving surgery, mastectomy, axillary lymph node dissection (ALND), and breast reconstruction. This article describes the incidence, prevalence, risk factors and time course for early postoperative effects and the role of prospective surveillance as a rehabilitation strategy to prevent and mitigate them. The most common early postoperative effects include wound issues such as cellulitis, flap necrosis, abscess, dehiscence, hematoma, and seroma. Appropriate treatment is necessary to avoid delay in wound healing that may increase the risk of long-term morbidity, unduly postpone systemic and radiation therapy, and delay rehabilitation. The presence of upper quarter dysfunction (UQD), defined as restricted upper quarter mobility, pain, lymphedema, and impaired sensation and strength, has been reported in over half of survivors after treatment for breast cancer. Moreover, evidence suggests that survivors who undergo breast reconstruction may be at higher risk of UQD. Ensuring the survivor's optimum functioning in the early postoperative time period is critical in the overall recovery from breast cancer. The formal collection of objective measures along with patient-reported outcome measures is recommended for the early detection of postoperative morbidity. Prospective surveillance, including preoperative assessment and structured surveillance, allows for early identification and timely rehabilitation. Early evidence supports a prospective approach to address and minimize postoperative effects.
适当和及时的康复对于乳腺癌手术后的恢复至关重要，包括保乳手术、乳房切除术、腋窝淋巴结清扫术 (ALND) 和乳房重建。本文描述了早期术后影响的发生率、患病率、危险因素和时间进程，以及前瞻性监测作为预防和减轻这些影响的康复策略的作用。最常见的早期术后影响包括伤口问题，如蜂窝织炎、皮瓣坏死、脓肿、裂开、血肿和血清肿。需要进行适当的治疗以避免伤口愈合延迟，这可能会增加长期发病率的风险，不必要地推迟全身和放射治疗，并延迟康复。上肢功能障碍 (UQD) 的存在，定义为上肢活动受限、疼痛、淋巴水肿、感觉和力量受损，在接受乳腺癌治疗后的幸存者中超过一半都有报道。此外，有证据表明，接受乳房重建的幸存者可能面临更高的 UQD 风险。确保幸存者在早期术后期间的最佳功能状态对于从乳腺癌中全面康复至关重要。建议对客观指标和患者报告的结果进行正式收集，以早期发现术后发病率。前瞻性监测，包括术前评估和结构化监测，可以早期发现并及时进行康复。早期证据支持采用前瞻性方法来解决和最小化术后影响。
