【作者】 吴佳；

【导师】 田野； 朱雅群；

【作者基本信息】 苏州大学 ， 肿瘤学， 2013， 硕士

【摘要】 目的：了解乳腺癌患者放射治疗后上肢淋巴水肿和肩关节功能障碍的发病情况，并分析上肢淋巴水肿发生相关的危险因素。方法：回顾分析了92例在我科接受术后辅助放疗的乳腺癌患者临床资料，并对其上肢并发症的情况进行主观症状及客观体征两方面评估，上肢淋巴水肿的主观症状采用FCAT-B+4量表评估，而客观体征采用对双侧手臂肩峰端下15cm和尺骨鹰嘴下15cm处进行周径测量的方法，肩关节功能障碍的主观症状评价患者日常生活活动能力，而客观体征测量肩关节活动度，计算在两种方法下上肢并发症的发病率，并用单因素方差分析及Logistic回归分析上肢淋巴水肿发生的危险因素。结果：上肢淋巴水肿发病率在主观症状及客观体征检查中分别为53.3%和32.6%，肩关节活动障碍发病率分别为57.6%和65.2%，其中客观体征检查发现锁骨上区照射组和未照射组上肢淋巴水肿发病率分别为37.8%和11.1%（P=0.03），腋窝淋巴结阳性组和腋窝淋巴结阴性组上肢淋巴水肿发病率分别为41.5%和11.1（P=0.005），术后分期为Ⅲ期组和早于Ⅲ期组上肢淋巴水肿发病率分别为52.5%和17.3%（P=0），多因素分析结果表明术后分期是上肢淋巴水肿的独立危险因素。结论：上肢并发症是乳腺癌患者术后加放射治疗后常见并发症，发病率较高，锁骨上区照射、腋窝淋巴结阳性及术后分期较晚是上肢淋巴水肿的可能危险因素，尽可能减少正常组织受照以降低发病率，应予以重视。更多还原

【Abstract】 Objective: To identify the probability of breast cancer-related arm lymphedema(BCRL) and impairments of shoulder function induced by radiotherapy in patients afterbreast cancer surgery and to analyze the relative risk factors contributing to development ofBCRL.Methods: A total of92patients with breast cancer were treated with lumpectomy ormodified radical mastectomy and afterwards conformal radiotherapy in our hospital. Thedetermination of upper-body morbidity was based on subjective symptoms felt by patientsand objective signs viewed. FCAT-B+4scoring system was introduced to commentpatients’ symptoms and circumference measurement was taken at15cm below theacromion process and15cm below the olecranon in both arms, impairments of shoulderfunction is assessed along with self reports of activities of daily living and range ofmotion.Then the actuarial rates of upper-body morbidity were determined.Univariateanalysis was performed by Chi-Square test, and multivariable analysis was undertaken bybinary logistic regression.Results: The actuarial rate of complains and signs of BCRL was respectively53.3%and32.6%, while being57.6%and65.2%in impairments of shoulder function. BCRL wasmore likely to develop in patients with advanced nodal status(41.5%vs.11.1%, P=0.005),patients with stage Ⅲ(52.5%vs.17.3%, P=0), and patients receiving supraclavicularirradiation (37.8%vs.11.1%, P=0.03). Stage is the independent risk factor leading tolymphedema after multivariable analysis.Conclusions: These results suggest that upper-body morbidity is the commoncomplication with high morbidity induced by postoperative radiotherapy. The risk factors of BCRL include advanced nodal status, late stage and supraclavicular irradiation,whichmay raise BCRL, which emphasizes the importance of further efforts to reduce the dose ofnormal tissue.更多还原