乳房切除术后上肢功能障碍的危险因素：单机构回顾性研究
Risk Factors for Upper Extremity Impairment after Mastectomy: A Single Institution Retrospective Review.
作者信息
Carr Hannah M, Patel Ronak A, Beederman Maureen R, Maassen Nicholas H, Hanson Summer E
机构信息
From the Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Chicago Medicine and Biological Sciences Division, Chicago, Ill.
Department of Orthopedic Surgery and Rehabilitation, University of Chicago Medicine and Biological Sciences Division, Chicago, Ill.
出版信息
Plast Reconstr Surg Glob Open. 2024 Jul 24;12(7):e5684. doi: 10.1097/GOX.0000000000005684. eCollection 2024 Jul.
BACKGROUND
Patients with breast cancer treated with mastectomy are more likely to develop upper extremity dysfunction compared with those treated with breast-conserving therapy. This study aimed to identify cancer and treatment characteristics that may be risk factors for development of upper extremity dysfunction in patients treated with mastectomy.
METHODS
The authors performed a retrospective chart review of patients at the University of Chicago who were treated with a unilateral or bilateral mastectomy from 2010 to 2020 and developed upper extremity dysfunction based on International Classification of Disease-10 codes. Patients were analyzed by side of body (left or right). Patient demographics and treatment characteristics were extracted from the electronic medical record.
RESULTS
In total, 259 patients met criteria and were included in our study. A total of 396 upper extremities were recorded as experiencing dysfunction and were analyzed. Mean age was 60 years (range = 28-96), and mean body mass index was 28.4 (SD = 7.5). An estimated 54% of patients underwent breast reconstruction. After multivariable analysis, chronic upper extremity pain was found to be associated with ipsilateral radiotherapy ( 0.001) and ipsilateral in situ cancer (0.041). Limited range of motion was found to be associated with ipsilateral invasive cancer ( 0.01), any ipsilateral mastectomy surgery ( 0.001), and ipsilateral radiotherapy ( 0.03). Musculoskeletal dysfunction was found to be associated with no ipsilateral modified radical mastectomy ( 0.033). No oncological or treatment characteristics were found to be associated with decreased strength or adhesive capsulitis. Furthermore, breast reconstruction (implant or autologous tissue based) was not associated with upper extremity dysfunction.
CONCLUSION
Breast cancer characteristics and treatment modalities may predispose patients treated with mastectomy to developing types of upper extremity dysfunction.
背景
与接受保乳治疗的患者相比，接受乳房切除术治疗的乳腺癌患者更易出现上肢功能障碍。本研究旨在确定可能是接受乳房切除术治疗的患者发生上肢功能障碍风险因素的癌症及治疗特征。
方法
作者对2010年至2020年在芝加哥大学接受单侧或双侧乳房切除术并根据国际疾病分类第10版编码出现上肢功能障碍的患者进行了回顾性病历审查。按身体侧别（左侧或右侧）对患者进行分析。从电子病历中提取患者人口统计学和治疗特征。
结果
共有259例患者符合标准并纳入本研究。共记录了396条出现功能障碍的上肢并进行分析。平均年龄为60岁（范围 = 28 - 96岁），平均体重指数为28.4（标准差 = 7.5）。估计54%的患者接受了乳房重建。多变量分析后发现，慢性上肢疼痛与同侧放疗（P = 0.001）和同侧原位癌（P = 0.041）相关。活动范围受限与同侧浸润性癌（P = 0.01）、任何同侧乳房切除手术（P = 0.001）和同侧放疗（P = 0.03）相关。肌肉骨骼功能障碍与未进行同侧改良根治性乳房切除术（P = 0.033）相关。未发现肿瘤学或治疗特征与力量下降或粘连性关节囊炎相关。此外，乳房重建（基于植入物或自体组织）与上肢功能障碍无关。
结论
乳腺癌特征和治疗方式可能使接受乳房切除术治疗的患者易发生上肢功能障碍类型。
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