Pillai Pramod R, Sharma Shekhar, Ahmed Sheikh Zahoor, Vijaykumar D K
Indian J Surg Oncol. 2010 Sep;1(3):263-9. doi: 10.1007/s13193-011-0046-x. Epub 2011 Mar 4.
Lymphedema of the upper extremity, in addition to being unsightly, can be painful, can limit the arm movements, increases the risk of infection and is psychologically distressing, serving as a constant reminder of cancer. 1. To ascertain the incidence of lymphedema in a hospital based population (in patients undergoing axillary dissection for breast cancer. 2. To determine the clinico-epidemilogical factors associated with the occurrence of lymphedema in these patients. For all patients undergoing axillary dissection, arm measurements were taken in the pre-& post-operative period from at least 3 sites; one in the arm, forearm and wrist (points fixed in reference to fixed bony landmarks). Patients included in this study were followed up for at least 12 months. Circumference difference of more than 5% was taken as mild lymphedema; more than 10% as moderate lymphedema and more than 15% as severe lymphedema. Data was analyzed using SPSS 11.0 statistical software. Of the 231 patients in this study mean age was 51.2 years, majority were housewives (71.9%) and postmenopausal (58.5%). Modified radical mastectomy (MRM), was performed on 203 (87.9%) patients. 57.2% patients had positive lymph nodes. The mean number of positive nodes was 6.52. Majority of the patients received chemo and radio therapy. Overall incidence of lymphedema was 41.1%. The definition of 5-10% increase as mild lymphedema may be a bit severe as in most patients with this increase, lymphedema is not clinically apparent. The incidence of moderate and severe lymphedema in our series is only 7.4%. The incidence of clinically significant lymphedema (moderate to severe lymphedema & symptomatic mild lymphedema) was 16.8%. Only axillary irradiation and pathological nodal status (pN3) emerged as significant risk factors for lymphedema development on multivariate analysis. Lymphedema once established is difficult to treat. Combination of axillary dissection with radiation and more nodal positivity seems to predispose to lymphedema. Prevention by means of sentinel node biopsy in early cases, good surgical technique, arm care post surgery, exercises and massage therapy may help reducing the incidence and/or severity.
上肢淋巴水肿不仅影响美观，还会引起疼痛，限制手臂活动，增加感染风险，造成心理压力，时刻提醒着癌症的存在。1. 确定医院人群中（接受乳腺癌腋窝清扫术的患者）淋巴水肿的发生率。2. 确定这些患者中与淋巴水肿发生相关的临床流行病学因素。对于所有接受腋窝清扫术的患者，在术前和术后至少从3个部位测量手臂；一个在手臂、前臂和手腕（参考固定的骨性标志确定测量点）。本研究纳入的患者随访至少12个月。周长差异超过5%被视为轻度淋巴水肿；超过10%为中度淋巴水肿；超过15%为重度淋巴水肿。使用SPSS 11.0统计软件分析数据。本研究中的231例患者平均年龄为51.2岁，大多数是家庭主妇（71.9%）且已绝经（58.5%）。203例（87.9%）患者接受了改良根治性乳房切除术（MRM）。57.2%的患者淋巴结阳性。阳性淋巴结的平均数量为6.52。大多数患者接受了化疗和放疗。淋巴水肿的总体发生率为41.1%。将增加5 - 10%定义为轻度淋巴水肿可能有点严格，因为在大多数有这种增加的患者中，淋巴水肿在临床上并不明显。我们系列研究中中度和重度淋巴水肿的发生率仅为7.4%。具有临床意义的淋巴水肿（中度至重度淋巴水肿及有症状的轻度淋巴水肿）的发生率为16.8%。多因素分析显示，仅腋窝放疗和病理淋巴结状态（pN3）是淋巴水肿发生的显著危险因素。淋巴水肿一旦形成就难以治疗。腋窝清扫术联合放疗以及更多的淋巴结阳性似乎易导致淋巴水肿。在早期病例中通过前哨淋巴结活检、良好的手术技术、术后手臂护理、运动和按摩治疗等预防措施可能有助于降低发生率和/或减轻严重程度。
