切换至 "中华医学电子期刊资源库"

中华损伤与修复杂志(电子版) ›› 2024, Vol. 19 ›› Issue (03) : 204 -207. doi: 10.3877/cma.j.issn.1673-9450.2024.03.004

淋巴水肿

基于多学科协作的预防性淋巴管-静脉吻合术在乳腺癌腋窝淋巴结清扫患者中的应用
蒙燕1, 唐如冰1, 蒋奕1, 陆华1, 苏玉兰1, 张琼1, 何英煜1,()   
  1. 1. 530021 南宁,广西医科大学附属肿瘤医院乳腺外科
  • 收稿日期:2024-03-18 出版日期:2024-06-01
  • 通信作者: 何英煜

Application of preventive lymphaticovenular anastomosis in breast cancer patients with axillary lymph node dissection based on multidisciplinary collabration

Yan Meng1, Rubing Tang1, Yi Jiang1, Hua Lu1, Yulan Su1, Qiong Zhang1, Yingyu He1,()   

  1. 1. Department of Breast Surgery, the Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, China
  • Received:2024-03-18 Published:2024-06-01
  • Corresponding author: Yingyu He
引用本文:

蒙燕, 唐如冰, 蒋奕, 陆华, 苏玉兰, 张琼, 何英煜. 基于多学科协作的预防性淋巴管-静脉吻合术在乳腺癌腋窝淋巴结清扫患者中的应用[J/OL]. 中华损伤与修复杂志(电子版), 2024, 19(03): 204-207.

Yan Meng, Rubing Tang, Yi Jiang, Hua Lu, Yulan Su, Qiong Zhang, Yingyu He. Application of preventive lymphaticovenular anastomosis in breast cancer patients with axillary lymph node dissection based on multidisciplinary collabration[J/OL]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2024, 19(03): 204-207.

目的

观察多学科协作模式下行腋窝淋巴结清扫术(ALND)同期预防性淋巴管-静脉吻合术(LVA)对乳腺癌患者术后上肢淋巴水肿及生存质量的影响。

方法

选择2022年8月至2023年7月广西医科大学附属肿瘤医院乳腺外科收治的行ALND同期预防性LVA乳腺癌患者17例,通过建立多学科团队,实施术前多学科会诊、辅助患者决策、术后康复指导、"互联网+"管理的医疗模式。对患者上肢周径实施监测,并采用中文版世界卫生组织生存质量量表简表(WHOQOL-BREF)评估患者术后生存质量。

结果

随访9.60~19.30(12.74±2.51)个月。术前双上肢周径差值0.50(0.03, 0.88)cm,末次随访时双上肢周径差值0.50(0.13, 1.00)cm,17例患者行ALND术后均未出现肢体淋巴水肿,肩关节功能恢复良好。末次随访时患者生存质量生理领域得分为(15.40±2.37)分,心理领域得分为(16.64±2.19)分,社会关系领域得分为(14.80±2.66)分,环境领域得分为(15.43±2.12)分,心理领域得分最高。

结论

多学科协作模式下实施预防性LVA,可增加乳腺癌患者的治疗决策参与度,减少术后淋巴水肿的发生,提高患者生存质量。

Objective

To observe the effect of axillary lymph node dissection (ALND) and preventive lymphaticovenular anastomosis (LVA) on postoperative upper limb lymphedema and quality of life in patients with breast cancer based on the multidisciplinary callabration model.

Methods

A total of 17 patients with breast cancer who underwent ALND and preventive LVA admitted to the Department of Breast Surgery of Affiliated Tumor Hospital of Guangxi Medical University from August 2022 to July 2023 were entrolled. By establishing a multidisciplinary team, the medical model of preoperative multi-disciplinary treatment, assisting patient decision-making, postoperative rehabilitation guidance, and internet plus management were implemented. Monitored the circumference of the upper limbs and evaluated the postoperative quality of life using the Chinese version of the WHOQOL-BREF.

Results

The follow-up time was 9.60-19.30 (12.74±2.51) months.The difference in the circumference of upper limbs was 0.50 (0.03, 0.88)cm before surgery and 0.50 (0.13, 1.00)cm at the last follow-up, no limb lymphedema occured after operation. At the last follow-up, the patient′s quality of life score was 15.40±2.37, 16.64±2.19, 14.80±2.66 and 15.43±2.12 in the physiological, psychological, social relations and environmental fields, respectively, and the highest scores was in the psychological fields.

Conclusion

Preventive LVA under the multidisciplinary callabration model can increase the participation of breast cancer patients in treatment decision-making, reduce the occurrence of postoperative lymphedema and improve the quality of life of patients.

[1]
Boughey JC, Suman VJ, Mittendorf EA, et al. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial[J]. JAMA, 2013, 310(14): 1455-1461.
[2]
Donker M, Van Tienhoven G, Straver M, et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial[J]. Lancet Oncol, 2014, 15(12): 1303-1310.
[3]
Galimberti V, Cole B, Viale G, et al. Axillary dissection versus no axillary dissection in patients with breast cancer and sentinel-node micrometastases (IBCSG 23-01): 10-year follow-up of a randomised, controlled phase 3 trial[J]. Lancet Oncol, 2018, 19(10): 1385-1393.
[4]
Krag DN, Anderson SJ, Julian TB, et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial[J]. Lancet Oncol, 2010, 11(10): 927-933.
[5]
Mclaughlin S, Brunelle C, Taghian A. Breast cancer-related lymphedema: risk factors, screening, management, and the impact of locoregional treatment[J]. J Clin Oncol, 2020, 38(20): 2341-2350.
[6]
蒋奕,廖晓明,唐玮,等. 套入式淋巴管静脉吻合在乳腺癌腋窝淋巴结清扫术同期预防性淋巴水肿手术中的应用1例并文献复习[J]. 中国癌症防治杂志2022, 14(2): 212-215.
[7]
Boccardo F, Casabona F, Friedman D, et al. Surgical prevention of arm lymphedema after breast cancer treatment[J]. Ann Surg Oncol, 2011, 18(9): 2500-2505.
[8]
Feldman S, Bansil H, Ascherman J, et al. Single institution experience with lymphatic microsurgical preventive healing approach (LYMPHA) for the primary prevention of lymphedema[J]. Ann Surg Oncol, 2015, 22(10): 3296-3301.
[9]
程舸畅,唐举玉. 妇科恶性肿瘤根治术后下肢淋巴水肿的外科治疗进展[J]. 中华显微外科杂志2022, 45(2): 230-235.
[10]
中华护理学会. 乳腺癌术后淋巴水肿预防和护理[EB/OL].(2021-03-13) [2024-03-20].

URL    
[11]
何英煜,蒙燕,李繁荣,等. 腹股沟薄层血管化淋巴结皮瓣移植术治疗乳腺癌术后Ⅲ期上肢淋巴水肿的护理[J]. 中国临床护理2023, 15(8): 484-487.
[12]
田子睿,姚敏,王拥军,等. 中文版Constant-Murley肩关节评分量表的研制与应用[J]. 中医正骨201931(5):20-21.
[13]
方积乾,万崇华,史明丽,等. 生存质量研究概况与测定量表[J]. 现代康复2000, 4(8): 1123-1126,1133.
[14]
Shen A, Qiang W, Zhang L, et al. Risk factors for breast cancer-related lymphedema: an umbrella review[J]. Ann Surg Oncol, 2024, 31(1): 284-302.
[15]
Braude L, Kirsten L, Gilchrist J, et al. A systematic review of women′s satisfaction and regret following risk-reducing mastectomy[J]. Patient Educ Couns, 2017, 100(12): 2182-2189.
[16]
Mcduff S, Mina A, Brunelle C, et al. Timing of lymphedema after treatment for breast cancer: when are patients most at risk?[J]. Int J Radiat Oncol Biol Phys, 2019, 103(1): 62-70.
[17]
郝元涛,方积乾,李彩霞,等. 世界卫生组织生命质量量表及其中文版 [J]. 国外医学(社会医学分册), 1999(3): 118-122.
[18]
刘英,李群,吕大鹏,等.有氧运动联合康复护理干预在乳腺癌术后淋巴水肿的应用效果[J].中华损伤与修复杂志(电子版)202116(2):170-174.
[1] 洪玮, 叶细容, 刘枝红, 杨银凤, 吕志红. 超声影像组学联合临床病理特征预测乳腺癌新辅助化疗完全病理缓解的价值[J/OL]. 中华医学超声杂志(电子版), 2024, 21(06): 571-579.
[2] 赵阳, 肖迎聪, 巨艳, 党晓智, 蔡林利, 薛文欣, 李洋, 肖瑶, 郭妤绮, 宋宏萍. 自动乳腺超声联合免疫组化早期预测乳腺癌新辅助化疗病理完全缓解的临床价值[J/OL]. 中华医学超声杂志(电子版), 2024, 21(04): 361-369.
[3] 刘伟, 牛云峰, 安杰. LINC01232 通过miR-516a-5p/BCL9 轴促进三阴性乳腺癌的恶性进展[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(06): 330-338.
[4] 杨柳, 宋振川, 王新乐. 乳腺癌改良根治术联合背阔肌复位的临床疗效评估[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(05): 269-273.
[5] 张钊, 骆成玉, 张树琦, 何平, 李旭斌. 不同术式治疗早期乳腺癌的效果及并发症发生率、复发率比较[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(05): 494-497.
[6] 宋佳, 汪波, 孙凯律, 商江峰, 吴旦平, 肇毅. 吲哚菁绿荧光显影联合亚甲蓝染色在乳腺癌前哨淋巴结活检中的应用[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(05): 498-501.
[7] 孙建娜, 孔令军, 任崇禧, 穆坤, 王晓蕊. 266例首诊Ⅳ期乳腺癌手术患者预后分析[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(05): 502-505.
[8] 唐丹萍, 王萍, 江孟蝶, 杨晓蓉. 自体脂肪移植在乳腺癌术后乳房重建的研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(05): 582-585.
[9] 黄程鑫, 陈莉, 刘伊楚, 王水良, 赖晓凤. OPA1 在乳腺癌组织的表达特征及在ER阳性乳腺癌细胞中的生物学功能研究[J/OL]. 中华细胞与干细胞杂志(电子版), 2024, 14(05): 275-284.
[10] 刘琦, 王守凯, 王帅, 苏雨晴, 马壮, 陈海军, 司丕蕾. 乳腺癌肿瘤内微生物组的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(09): 841-845.
[11] 崔军威, 蔡华丽, 胡艺冰, 胡慧. 亚甲蓝联合金属定位夹及定位钩针标记在乳腺癌辅助化疗后评估腋窝转移淋巴结的临床应用价值探究[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 625-632.
[12] 王誉英, 刘世伟, 王睿, 曾娅玲, 涂禧慧, 张蒲蓉. 老年乳腺癌新辅助治疗病理完全缓解的预测因素分析[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 641-646.
[13] 王帅, 张志远, 苏雨晴, 李雯雯, 王守凯, 刘琦, 李文涛. 孟德尔随机化及其在乳腺癌研究中的应用进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 671-676.
[14] 张梦婷, 穷拉姆, 色珍, 李逸群, 德庆旺姆. 西藏地区藏族乳腺癌新辅助化疗的真实世界研究[J/OL]. 中华临床医师杂志(电子版), 2024, 18(05): 441-446.
[15] 赵阳, 肖迎聪, 巨艳, 党晓智, 蔡林利, 薛文欣, 李洋, 肖瑶, 郭妤绮, 宋宏萍. 基于自动乳腺超声的列线图模型早期预测HER-2阳性乳腺癌新辅助化疗病理完全缓解的临床价值[J/OL]. 中华临床医师杂志(电子版), 2024, 18(04): 355-362.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?