乳腺癌术后上肢淋巴水肿发病的危险因素

马小开; 黄建康; 王万霞; 高学云; 彭德峰; 陈春春; 李玉龙

doi:10.16462/j.cnki.zhjbkz.2020.07.021

乳腺癌术后上肢淋巴水肿发病的危险因素

doi: 10.16462/j.cnki.zhjbkz.2020.07.021

233004 蚌埠, 蚌埠医学院第一附属医院甲乳外科一病区

基金项目:

安徽省高校自然科学基金重点项目 KJ2019A0347

蚌埠医学院自然科学基金重点项目 BYKY1826ZD

详细信息

通讯作者:
马小开, E-mail:mak0707@163.com

中图分类号: R181.3
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出版历程
- 收稿日期: 2020-04-25
- 修回日期: 2020-05-26
- 刊出日期: 2020-07-10

Analysis of the incidence and risk factors of breast cancer-related upper limb lymphedema in postoperative patients

The First Department of Thyroid and Breast Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China

Funds:

Key Projects of Natural Science Foundation of Anhui Province University KJ2019A0347

Key Projects of Natural Science Foundation of Bengbu Medical College BYKY1826ZD

More Information

Corresponding author: MA Xiao-kai, E-mail: mak0707@163.com

摘要

摘要: 目的分析乳腺癌术后上肢淋巴水肿（breast cancer related lymphedema，BCRL）发生的危险因素。方法随访2008年7月―2019年11月蚌埠医学院第一附属医院甲乳外科收住的62例乳腺癌患者，采用5点周径测量法结合Norman问卷评估上肢淋巴水肿发生情况，结合患者临床资料分析BCRL发生的危险因素。结果 62例患者中发生上肢淋巴水肿22例（35.5%），轻度水肿20例，中度水肿2例；单因素分析结果提示BCRL与患者的年龄、体重指数（body mass index，BMI）、腋窝淋巴结清扫数量、腋窝第Ⅲ组淋巴结清扫及手术时间有关（均有P < 0.05）；多因素多分类Logistic回归分析模型分析结果提示患者的年龄、BMI及手术时间是BCRL发生的独立危险因素（均有P < 0.05）。结论乳腺癌患者术后早期即可发生上肢淋巴水肿，尤其是对于年龄≥53岁、BMI≥27 kg/m²及术后时间≥6月的患者，应积极采取预防性干预措施，以预防和减少BCRL的发生。
- 乳腺癌 /
- 淋巴水肿 /
- 乳腺癌相关淋巴水肿 /
- 危险因素
Abstract: Objective The purpose of this study was to explore the risk factors of breast cancer-related upper limb lymphedema (BCRL) in postoperative patients. Methods There were 62 patients were enrolled from the First Affiliated Hospital of Bengbu Medical College in the present study from July 2008 to November 2019. The 5-point circumference measurement method combined with the Norman questionnaire to assess the occurrence of upper extremity lymphedema, and to analyze the incidence and risk factors of BCRL according to the clinical data. Results Of the 62 patients, upper limb lymphedema occurred in 22 (35.5%), 20 had mild edema, and 2 had moderate edema. Univariate analysis results suggest that BCRL is related to the patient's age, body mass index (BMI), number of axillary lymph node dissection, axillary group Ⅲ lymph node dissection, and postoperative time (all P < 0.05). Binary logistic multivariate analysis results suggest that age, BMI, and postoperative time are independent risk factors for BCRL (all P < 0.05). Conclusions BCRL had a certain incidence, and it can occur in the early postoperative period, especially for patients age ≥ 53 years old, BMI ≥ 27 kg/m², and those who accepted operation more than 6 months, preventive interventions should be action taken to prevent and reduce the occurrence of BCRL.
- Breast cancer /
- Lymphedema /
- Breast cancer-related lymphedema /
- Risk factors

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表 1 BCRL发生位置[n(%)]

Table 1. Location of BCRL [n(%)]

上肢周径最大差值位置(距尺骨茎突距离，cm)	例数(n)	BCRL患者	非BCRL患者	χ²值	P值
0	5(8.1)	0(0.0)	5(100.0)	11.797	0.013
10	9(14.5)	0(0.0)	9(100.0)
20	10(16.1)	5(50.0)	5(50.0)
30	25(40.3)	13(52.0)	12(48.0)
40	13(21.0)	4(30.8)	9(69.2)

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表 2 BCRL患者相关危险因素单因素分析[n (%)]

Table 2. Univariate analysis of related risk factors in patients with BCRL[n (%)]

变量	n(例)	BCRL		χ²值	P值
变量	n(例)	发生	未发生	χ²值	P值
年龄(岁)				4.449	0.035
≥53	23(37.1)	12(52.2)	11(47.8)
< 53	39(62.9)	10(25.6)	29(74.4)
淋巴结数目				4.062	0.044
≥21	16(25.8)	9(56.3)	7(43.7)
< 21	46(74.2)	13(28.3)	33(71.7)
淋巴结转移				3.604	0.058
是	24(38.7)	12(50.0)	12(50.0)
否	38(61.3)	10(26.3)	28(73.7)
BMI(kg/m²)				4.449	0.035
≥27	23(37.1)	12(52.2)	11(47.8)
< 27	39(62.9)	10(25.6)	29(74.4)
Ⅲ组淋巴结				8.102	0.004
清扫	11(17.7)	8(72.7)	3(27.3)
未清扫	51(82.3)	14(27.5)	37(72.5)
术后时间				11.806	0.001
≥6月	22(35.5)	14(63.6)	8(36.4)
< 6月	40(64.5)	8(20.0)	32(80.0)
辅助放疗				1.617	0.204
是	7(11.3)	4(57.1)	3(42.9)
否	55(88.7)	18(32.7)	37(67.3)

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表 3 BCRL患者相关危险因素多因素分析

Table 3. Multivariate analysis of related risk factors in patients with BCRL

变量	β值	Wald值	OR(95% CI)值	P值
年龄(≥53岁)	-1.810	4.943	0.164(0.033~0.807)	0.026
手术时间(≥6月)	2.405	9.284	11.078(2.358~52.035)	0.002
BMI(≥27 kg/m²)	-1.509	4.186	0.221(0.052~0.939)	0.041
常量	1.222	0.293	3.393	0.588

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