乳腺癌术后上肢水肿诊疗现状分析.docVIP

乳腺癌术后上肢水肿诊疗现状分析 唐武军，王笑民( (首都医科大学附属北京中医医院肿瘤科，北京，100010) [摘要] 目的：介绍乳腺癌术后上肢淋巴水肿的诊疗现状。方法：对近10年有关乳腺癌术后患侧上肢淋巴水肿的发病原因、诊断、治疗及预防等方面的资料进行综述。结果：乳腺癌术后上肢淋巴水肿严重危害乳腺癌患者的身心健康和生活质量。按摩、压力泵、微波等物理治疗对轻中度水肿有效，但易反复；药物治疗效果不理想；重症患者可考虑手术治疗。结论：水肿一旦形成则很难治愈，应把工作的重点放在预防上。前哨淋巴结活检术取代腋窝淋巴结解剖，有望从根本上解决上肢淋巴水肿等并发症。 [关键词] 乳腺癌；淋巴水肿；诊疗现状 Current Status of Diagnosis and Treatment in Upper Limb Lymphedema after Mastectomy Tangwujun, Wangxiaomin. Oncology department of Beijing Chinese Medicine Hospital pertain to Capital Medical University, Beijing, 100010 [Abstract] Objective: To introduce current status of diagnosis and treatment in upper limb lymphedema after mastectomy. Method: To review researches on the pathogenesis, diagnosis, treatment, prevention and so on published in the last ten years. Result: Upper limb lymphedema after mastectomy can severely threaten physical and mental health and life quality of the patients. The mild to moderate dropsy can be effectively treated by massage, booster pump, microwave and other physiotherapies, however they frequently relapse. The medication is not ideal. Severe cases might consider operation. Conclusion: Once the dropsy is generated, it can hardly be cured. Prevention should be the key point. Axillary lymph node dissection (ALDN) can be substituted by the Sentinel Lymph node biopsy(SLNB), which might fundamentally solve the complications of upper limb lymphedema. [key word] Breast Cancer; lymphedema; status of diagnosis and treatment 乳腺癌是女性最常见的恶性肿瘤之一,在欧美等西方国家已成为女性肿瘤的首位,在中国乳腺癌的发病率也呈逐年上升趋势[1]。目前手术仍是乳腺癌的首选治疗方法。各式手术都需要同时行腋窝淋巴结解剖（Axillary Lymph Node Dissection，ALND）,其目的是为了清除腋窝淋巴结,确定分期,判断预后,决定综合治疗方案[2]。ALND切断了大量淋巴管，淋巴液主要依靠代偿机制进行引流。在此基础上如果再出现损害代偿机制或增加淋巴负荷的因素则较容易发生淋巴水肿。引起间质中蛋白质的浓度明显升高，使组织的胶体渗透压进一步增高，水肿加重。富含蛋白质的淋巴液可以刺激间质中纤维母细胞增殖和释放胶原蛋白。于是皮下组织发生纤维化，进一步限制了淋巴引流，由此形成恶性循环[3]。乳腺癌术后患侧上肢淋巴水肿的发病率为6～30%[4]，可导致外观异常、乏力、反复感染和上肢功能障碍,从而严重影响病人的生活质量，给病人造成极大的痛苦，是目前国内、外临床治疗的难题。 1相关因素 1.1手术因素 手术方式与乳腺癌术后上肢淋巴水肿的发生密切相关，随着手术方式的改良，淋巴水肿的发生率也逐渐降低，改良根治术后淋巴水肿发生率仅为根治术者的1/3~1/2。手术切口的选择对上肢淋巴水肿的