中国实用外科杂志

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乳腺癌术后上肢淋巴水肿预防措施及治疗原则

张保宁   

  1. 中国医学科学院肿瘤医院, 北京100021
  • 出版日期:2015-07-01 发布日期:2015-06-30

  • Online:2015-07-01 Published:2015-06-30

摘要:

前瞻性研究显示乳腺癌术后上肢淋巴水肿的发生率为21.4%,且全球其发生率存在地域差异。乳腺癌病人预防淋巴水肿的理念应贯串始终。预防措施包括规范化手术与放疗、功能锻炼及日常注意事项。淋巴水肿可采取保守治疗、药物及手术治疗。术式可包括降低淋巴系统负荷如病变组织切除术、负压抽吸术等,促进淋巴引流如筋膜条引流、网膜引流及带蒂皮瓣引流术等,重建淋巴通道如淋巴-静脉系统吻合术、淋巴管移植术 、静脉代替淋巴管移植术、淋巴结移植术等。上述治疗虽取得一定疗效,但未能从根本上解决问题,疗效难以持久且个体差异较大。治疗原则强调早期、长期、综合、个体化。

关键词: 乳腺癌, 上肢, 淋巴水肿

Abstract:

Prevention strategies and treatment principles of upper limb lymphedema after breast cancer operation                          ZHANG Bao-ning. Cancer Hospital Chinese Academy of Medical Sciences, Beijing 100021, China
Abstract    The incidence of upper limb lymphedema was 21.4% among breast cancer cases performed operation reported in prospective studies and the rate had a geographic variation worldwide. Surgeons should pay attention to the prevention of lymphedema for breast cancer patients. Preventive strategies include standardized operation, radiotherapy, functional exercise and life attentions. Treatment options include conservative treatment, drug and surgical therapies. Surgeries are to reduce lymphetic system load, such as excision of lesion and negative pressure suction technique; to promote lymphetic drainage, such as article fascia drainage, retinal drainage and pedicle flap drainage; and to reconstruct lymphetic channels, such as lymphetic venous anastomosis, lymphetic vessel grafting, vein replacing lymphetic vessel transplantation, and lymph node transplantation. However, the efficacy is unsustainable and hetergeneous. The therapy should focus on early stage, sustainability, integration and individualization.

Key words: breast cancer, upper limb, lymphedema