关键词: 乳腺肿瘤, 淋巴水肿, 危险因素

Abstract: ObjectiveTo investigate the risk factors of lymphedema in patients with breast cancer after operation. MethodsFrom January 2012 to May 2016, the clinical data of 350 patients with breast cancer who underwent surgical treatment in First People′s Hospital of Foshan were collected. According to the occurrence of postoperative lymphedema, the patients were divided into lymphedema group (87 cases) and non lymphedema group (263 cases). The possible risk factors were evaluated from general demographic indicators, pathological data of breast cancer, perioperative related data and preventive action implementation. Results General demographic data: there was no correlation between the incidence of lymphedema and age, preoperative body mass index (BMI), postoperative BMI, educational level, marital status, residence, family income, menopause, hypertension history (P＞0.05).  Pathological data of breast cancer: the occurrence of lymphedema was related with tumor quadrant (χ2=20.039, P＜0.001) and axillary lymph node metastasis (Z=4.713, P＜0.001), but not related with clinical stage and pathological type of tumor (both P≥0.05).  Perioperative data: the occurrence of lymphedema was related with the type of incision (χ2=16.921, P＜0.001), axillary lymph node dissection level (χ2=4.433, P＜0.001), the number of axillary lymph node dissection (Z=3.620, P＜0.001), radiotherapy (χ2=33.290, P＜0.001), endocrine therapy (χ2=10.428, P=0.001), but not related with surgical methods, postoperative complications (subcutaneous fluid, upper limbedema, infection, serum swelling), chemotherapy and neoadjuvant chemotherapy (all P＞0.05).  Comparison of preventive behaviors: avoiding injuries such as cuts and bites (χ2=15.754, P＜0.001), trimming nails (χ2=9.018,P=0.003), avoiding grasping heavy objects (χ2=11.828, P=0.001) were related with postoperative lymphedema, but other preventive behaviors did not show significant correlation (all P＞0.05).  Lymphedema as the dependent variable, multivariate logistic regression analysis results showed that tumor located in the upper outer quadrant (OR=3.943, P＜0.001), surgical incision for longitudinal incision (OR=3.767, P＜0.001) or oblique incision (OR=2.492, P＜0.001), Ⅱ (OR=1.707, P=0.003) or Ⅲ (OR=4.211, P＜0.001) axillary lymph node dissection, breast/chest wall radiotherapy (OR=2.869, P＜0.001) or lymph node radiotherapy (OR=4.829, P＜0.001), grabing heavy objects or not (OR=3.264, P＜0.001), avoiding injuries such as cuts and bites  (OR=2.602, P＜0.001) were independent risk influence factors of postoperative lymphedema. ConclusionA variety of factors affect the occurrence of postoperative lymphedema in breast cancer patients. Tumors located in the upper outer quadrant, longitudinal or oblique incision, high level of axillary lymph node dissection, radiotherapy, having  injuries such as cuts and bites, grabing heavy objects are independent risk influence factors of postoperative lymphedema in breast cancer patients.  More attention should be paid to the high risk of lymphedema, and the preventive measures should be taken actively.

Key words: Breast neoplasms, Lymphedema, Risk factors