Mastrella Adriana de S, Freitas-Junior Ruffo, Paulinelli Régis R, Soares Leonardo R
Mastology Program, Hospital das Clinicas of the Federal University of Goiás, Goiânia, Brazil.
J Clin Nurs. 2014 Sep;23(17-18):2525-31. doi: 10.1111/jocn.12443. Epub 2013 Dec 26.
To evaluate the incidence of winged scapula following surgical breast cancer treatment, determine its evolution over time and correlate factors that might influence this incidence.
Winged scapula is a complication that may occur as a result of exposing the long thoracic nerve during axillary lymphadenectomy for the treatment for breast cancer. There is no consensus in the literature about the incidence of this complication after surgical treatment for breast cancer, and complication rates range from 1·5-74%.
This is a prospective cohort study.
A prospective cohort study was conducted including 57 patients with breast cancer who underwent surgical treatment. Each patient was assessed before and after the surgery, by means of Hoppenfeld manoeuvre. The incidence rate of winged scapula was calculated at four different times.
At the preoperative assessment, none of the patients presented with winged scapula, while 16 patients (28·1%) were shown to have this complication after the procedure. The incidence of winged scapula decreased over time. Factors associated with winged scapula were as follows: patients younger than 50 years, clinical stage I and II and no neoadjuvant chemotherapy. Other factors that were evaluated, such as type of surgery, number of lymph nodes compromised and removed, as well as body mass index, were not associated with the risk of winged scapula.
This study demonstrated that the incidence of winged scapula is low and decreased over time. Furthermore, a greater incidence of winged scapula was noted in young women at an initial stage of the disease who had not been treated with neoadjuvant chemotherapy.
The result of this work may have great impact, for demonstrating what risk factors are significantly associated with winged scapula after surgical treatment for breast cancer.
评估乳腺癌手术治疗后翼状肩胛的发生率，确定其随时间的演变情况，并关联可能影响该发生率的因素。
翼状肩胛是一种并发症，可能因乳腺癌治疗的腋窝淋巴结清扫术中暴露胸长神经而发生。关于乳腺癌手术治疗后该并发症的发生率，文献中尚无共识，并发症发生率在1.5%至74%之间。
这是一项前瞻性队列研究。
进行了一项前瞻性队列研究，纳入57例接受手术治疗的乳腺癌患者。每位患者在手术前后均通过霍彭费尔德手法进行评估。在四个不同时间点计算翼状肩胛的发生率。
术前评估时，所有患者均未出现翼状肩胛，而术后有16例患者（28.1%）出现了该并发症。翼状肩胛的发生率随时间下降。与翼状肩胛相关的因素如下：年龄小于50岁的患者、临床I期和II期以及未接受新辅助化疗。其他评估因素，如手术类型、受累及切除的淋巴结数量以及体重指数，均与翼状肩胛的风险无关。
本研究表明，翼状肩胛的发生率较低且随时间下降。此外，在疾病初期未接受新辅助化疗的年轻女性中，翼状肩胛的发生率更高。
这项工作的结果可能具有重大影响，因为它证明了乳腺癌手术治疗后与翼状肩胛显著相关的危险因素。
