国际肿瘤学杂志

国际肿瘤学杂志 ›› 2016, Vol. 43 ›› Issue (1): 1-4.doi: 10.3760/cma.j.issn.1673-422X.2016.01.001

• 论著 •    下一篇

一期静脉淋巴管吻合预防乳腺癌根治术后上肢淋巴水肿的临床研究

侍朋举,赵刚,蔡海峰,刘会仁,朱鹏飞,赵燕会,张铁山   

  1. 063000 华北理工大学附属唐山市第二医院手四科（侍朋举、赵刚、刘会仁、朱鹏飞、赵燕会、张铁山）；华北理工大学附属唐山市肿瘤医院乳腺外科（蔡海峰）
  • 收稿日期:2015-05-12 出版日期:2016-01-08 发布日期:2015-12-03
  • 通讯作者: 赵刚 E-mail:zhaog998@126.com
  • 基金资助:

    唐山市科学技术研究与发展计划（12150222B-8）

Clinical study of onestage lymphatics-venous anastomosis to prevent upper extremity lymphedema of breast cancer after radical resection

Shi Pengju, Zhao Gang, Cai Haifeng, Liu Huiren, Zhu Pengfei, Zhao Yanhui, Zhang Tieshan   

  1. Fourth Department of Hand Surgery, Second Hospital of Tangshan, North China University of Science and Technology, Tangshan 063000, China
  • Received:2015-05-12 Online:2016-01-08 Published:2015-12-03
  • Contact: Zhao Gang E-mail:zhaog998@126.com
  • Supported by:

    Science and Technology Research and Development Program of Tangshan City of China (12150222B-8)

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摘要： 目的  观察乳腺癌根治术中一期行静脉淋巴管吻合术在预防术后患侧上肢淋巴水肿中的价值。方法  收集2010年3月—2013年5月华北理工大学附属唐山市肿瘤医院收治的90例乳腺癌需行根治术患者作为研究对象，应用区组随机化分组法将其均分为对照组与治疗组各45例，随机分配方案隐藏。两组均接受乳腺癌根治手术治疗，治疗组在此基础上一期行静脉淋巴管吻合术，对比两组患者手术时间、出血量、住院时间、术后并发症及腋窝淋巴结清扫数目上的差异，比较两组患者术后上肢淋巴水肿的发生率。结果  治疗组和对照组手术时间分别为(152.82±18.76)min、(78.92±10.33)min，出血量分别为(416.64±94.65)ml、(250.84±63.17)ml，差异均有统计学意义（t=-20.39，P=0.00，t=-4.48，P=0.00）。治疗组和对照组平均住院时间分别为(14.91±5.44)d、(13.45±2.36)d，腋窝淋巴结清扫个数分别为(14.63±3.37)个、(14.37±3.18)个，发生术后并发症患者分别为9例（20.00%）和5例（11.11%），差异均无统计学意义（t=-0.47，P=0.64；t=0.75，P=0.46；χ2=1.35，P=0.38）。与对照组相比，治疗组上肢淋巴水肿发生率更低（13.95%∶40.91%），肿胀程度减轻，组间差异具有统计学意义（χ2=8.48，P=0.03）。结论  乳腺癌根治术中一期行静脉淋巴管吻合术可以有效地转移淋巴分流至静脉循环，降低患侧上肢淋巴水肿的发生率，具有显著的预防作用。

关键词: 乳腺肿瘤, 淋巴水肿, 乳房切除术, 根治性, 吻合术, 外科

Abstract: Objective To investigate the value of onestage lymphaticsvenous anastomosis in radical mastectomy of breast cancer to prevent postmastectomy upper limb lymphedema. MethodsNinety patients requiring radical mastectomy of breast cancer in  Tangshan Tumor Hospital Affiliated to North China University of Science and Technology from March 2010 to May 2013 were collected as the objects. They were divided into the control group (45 cases) and the treatment group (45 cases) using block randomized grouping (concealment of allocation). Both groups underwent radical mastectomy of breast cancer, and the treatment group was treated with onestage lymphaticsvenous anastomosis on the basis of radical mastectomy. The operation times, amount of bleeding, hospitalization times, postoperative complications and the numbers of axillary lymph node dissection of the patients in the two groups were compared, and the postoperative upper limb lymphedema incidence rates of the patients in the two groups were compared. ResultsThe operative times of the patients in the treatment group and the control group were (152.82±18.76)min and (78.92±10.33)min respectively, and amount of bleeding were (416.64±94.65)ml and (250.84±63.17)ml, with statistical significances (t=-20.39, P=0.00; t=-4.48, P=0.00). The average hospitalization times of the patients in the treatment group and the control group were (14.91±5.44)d and (13.45±2.36)d respectively, the numbers of axillary lymph node dissection were 14.63±3.37 and 14.37±3.18, the numbers of postoperative complications occurred were 9 cases (20.00%) and 5 cases (11.11%), with no statistical significances (t=-0.47, P=0.64; t=0.75, P=0.46; χ2=1.35, P=0.38). Compared with the control group, the treatment group has lower incidence of upper extremity lymphedema (13.95% vs. 40.91%) and lower swelling degree, with statistical significance (χ2=8.48, P=0.03). ConclusionOnestage lymphaticsvenous anastomosis in radical mastectomy of breast cancer can effectively transfer lymph diversion to the venous circulation and reduce the incidence of limb lymphedema, which has significant preventive effect.

Key words: Breast neoplasms, Lymphedema, Mastectomy, radical, Anastomosis, surgical