乳腺癌患者根治术后上肢淋巴水肿的管理
Management of Post-Mastectomy Upper Limb Lymphedema in Patients with Breast Cancer
DOI: 10.12677/WJCR.2016.64007, PDF, HTML, 下载: 1,990  浏览: 4,617 
作者: 蒋春儿, 邹德宏:浙江省肿瘤医院,乳腺外科,浙江 杭州;王方正*:浙江省肿瘤医院,放疗科,浙江 杭州
关键词: 淋巴水肿乳腺癌根治术后并发症Lymphedema Breast Cancer Post-Mastectomy Complications
摘要: 淋巴水肿是一种淋巴回流障碍引起的慢性、进展性的并发症。接受过腋窝淋巴结清扫的乳腺癌患者中上肢淋巴水肿发生率为16%~40%。而且在前哨淋巴结清扫患者中只有3.5%出现上肢淋巴水肿。然而上肢淋巴水肿并不是目前新出现的并发症,外科治疗的进展为淋巴水肿的管理提供治疗手段,并改善其疗效。因此本文的目的是对乳腺癌术后上肢水肿的外科治疗手段和目前进展做一综述。
Abstract: Lymphedema is a chronic, progressive complication caused by an imbalance of lymphatic flow. Upper limb lymphedema has been reported in 16% - 40% of breast cancer patients following axillary lymph node dissection. Furthermore, lymphedema followed sentinel lymph node biopsy alone has been reported in 3.5% of patients. While the disease process is not new, there has been significant progress in the surgical treatment for lymphedema that can offer alternatives and improvements in management. The purpose of this review is to provide a comprehensive overview of the current advances and surgical treatment options for upper limb lymphedema after mastectomy for patients with breast cancer.
文章引用:蒋春儿, 王方正, 邹德宏. 乳腺癌患者根治术后上肢淋巴水肿的管理[J]. 世界肿瘤研究, 2016, 6(4): 36-42. http://dx.doi.org/10.12677/WJCR.2016.64007

参考文献

[1] Langer, I., Guller, U., Berclaz, G., et al. (2007) Morbidity of Sentinel Lymph Node Biopsy (SLN) Alone versus SLN and Completion Axillary Lymph Node Dissection after Breast Cancer Surgery: A Prospective Swiss Multicenter Study on 659 Patients. Annals of Surgery, 245, 452-461. https://doi.org/10.1097/01.sla.0000245472.47748.ec
[2] Rockson, S.G. (2008) Diagnosis and Management of Lymphatic Vascular Disease. Journal of the American College of Cardiology, 52, 799-806. https://doi.org/10.1016/j.jacc.2008.06.005
[3] Miller, C.L., Specht, M.C., Skolny, M.N., et al. (2014) Risk of Lymphedema after Mastectomy: Potential Benefit of Applying ACOSOG Z0011 Protocol to Mastectomy Patients. Breast Cancer Research and Treatment, 144, 71-77. https://doi.org/10.1007/s10549-014-2856-3
[4] Soran, A., Ozmen, T., McGuire, K.P., et al. (2014) The Importance of Detection of Subclinical Lymphedema for the Prevention of Breast Cancer-Related Clinical Lymphedema after Axillary Lymph Node Dissection; a Prospective Observational Study. Lymphatic Research and Biology, 12, 289-294. https://doi.org/10.1089/lrb.2014.0035
[5] Fu, Y., Chung, D., Cao, M.A., et al. (2014) Is Axillary Lymph Node Dissection Necessary after Sentinel Lymph Node Biopsy in Patients with Mastectomy and Pathological N1 Breast Cancer? Annals of Surgical Oncology, 21, 4109-4123. https://doi.org/10.1245/s10434-014-3814-3
[6] Sackey, H., Magnuson, A., Sandelin, K., et al. (2014) Arm Lymphoedema after Axillary Surgery in Women with Invasive Breast Cancer. British Journal of Surgery, 101, 390-397. https://doi.org/10.1002/bjs.9401
[7] Bunke, N., Brown, K. and Bergan, J. (2009) Phlebolymphemeda: Usually Unrecognized, Often Poorly Treated. Perspectives in Vascular Surgery and Endovascular Therapy, 21, 65-68. https://doi.org/10.1177/1531003509337155
[8] Lee, B., Andrade, M., Bergan, J., et al. (2010) Diagnosis and Treatment of Primary Lymphedema. Consensus Document of the International Union of Phlebology (IUP)-2009. International Angiology, 29, 454-470.
[9] Das, N., Baumgartner, R.N., Riley, E.C., et al. (2015) Treatment-Related Risk Factors for Arm Lymphedema among Long-Term Breast Cancer Survivors. Journal of Cancer Survivorship, 9, 422-430. https://doi.org/10.1007/s11764-014-0416-9
[10] Boughey, J.C., Hoskin, T.L., Cheville, A.L., et al. (2014) Risk Factors Associated with Breast Lymphedema. Annals of Surgical Oncology, 21, 1202-1208. https://doi.org/10.1245/s10434-013-3408-5
[11] Coriddi, M., Khansa, I., Stephens, J., Miller, M., Boehmler, J. and Tiwari, P. (2015) Analysis of Factors Contributing to Severity of Breast Cancer-Related Lymphedema. Annals of Plastic Surgery, 74, 22-25. https://doi.org/10.1097/SAP.0b013e31828d7285
[12] Cheville, A.L., McGarvey, C.L., Petrek, J.A., Russo, S.A., Thiadens, S.R.J. and Taylor, M.E. (2003) The Grading of Lymphedema in Oncology Clinical Trials. Seminars in Radiation Oncology, 13, 214-225. https://doi.org/10.1016/S1053-4296(03)00038-9
[13] Campisi, C. and Boccardo, F. (2004) Microsurgical Techniques for Lymphedema Treatment: Derivative Lymphatic-Venous Microsurgery. World Journal of Surgery, 28, 609-613. https://doi.org/10.1007/s00268-004-7252-4
[14] Yamamoto, T., Narushima, M., Doi, K., et al. (2011) Characteristic Indocyanine Green Lymphography Findings in Lower Extremity Lymphedema: The Generation of a Novel Lymphedema Severity Staging System Using Dermal Backflow Patterns. Plastic & Reconstructive Surgery, 127, 1979-1986. https://doi.org/10.1097/PRS.0b013e31820cf5df
[15] Do, J.H., Kim, W., Cho, Y.K., et al. (2015) Effects of Resistance Exercises and Complex Decongestive Therapy on Arm Function and Muscular Strength in Breast Cancer Related Lymphedema. Lymphology, 48, 184-196.
[16] Pekyavaş, N.Ö., Tunay, V.B., Akbayrak, T., Kaya, S. and Karataş, M. (2014) Complex Decongestive Therapy and Taping for Patients with Postmastectomy Lymphedema: A Randomized Controlled Study. European Journal of Oncology Nursing, 18, 585-590. https://doi.org/10.1016/j.ejon.2014.06.010
[17] Leung, N., Furniss, D. and Giele, H. (2015) Modern Surgical Management of Breast Cancer Therapy Related Upper Limb and Breast Lymphoedema. Maturitas, 80, 384-390. https://doi.org/10.1016/j.maturitas.2015.01.012
[18] Charles, R. (1901) The Surgical Technique and Operative Treatment of Elephantiasis on the Generative Organs Based on a Series of 140 Successful Cases. Indian Medical Gazette, 36, 84-91.
[19] Homans, J. (1936) The Treatment of Elephantiasis of the Legs—A Preliminary Report. The New England Journal of Medicine, 215, 1099-1104. https://doi.org/10.1056/NEJM193612102152401
[20] Gloviczki, P. (1999) Principles of Surgical Treatment of Chronic Lymphoedema. International Angiology, 18, 42-46.
[21] Brorson, H. (2011) Surgical Treatment of Postmastectomy Lymphedema Liposuction. In: Lee, B., Bergan, J. and Rockson, S.G., Eds., Lymphedema: A Concise Compendium of Theory and Practice, Springer, London, 409-416. https://doi.org/10.1007/978-0-85729-567-5_50
[22] Brorson, H. and Svensson, H. (1998) Liposuction Combined with Controlled Compression Therapy Reduces Arm Lymphedema More Effectively than Controlled Compression Therapy Alone. Plastic & Reconstructive Surgery, 102, 1058-1067. https://doi.org/10.1097/00006534-199809020-00021
[23] Schaverien, M.V., Munro, K.J., Baker, P.A. and Munnoch, D.A. (2012) Liposuction for Chronic Lymphoedema of the Upper Limb: 5 Years of Experience. Journal of Plastic, Reconstructive & Aesthetic Surgery, 65, 935-942. https://doi.org/10.1016/j.bjps.2012.01.021
[24] Hou, C., Wu, X. and Jin, X. (2008) Autologous Bone Marrow Stromal Cells Transplantation for the Treatment of Secondary Arm Lymphedema: A Prospective Controlled Study in Patients with Breast Cancer Related Lymphedema. Japanese Journal of Clinical Oncology, 38, 670-674. https://doi.org/10.1093/jjco/hyn090
[25] Maldonado, G.E., Perez, C.A., Covarrubias, E.E., et al. (2011) Autologous Stem Cells for the Treatment of Post-Mas- tectomy Lymphedema: A Pilot Study. Cytotherapy, 13, 1249-1255. https://doi.org/10.3109/14653249.2011.594791
[26] Becker, C., Arrive, L., Saaristo, A., et al. (2012) Surgical Treatment of Congenital Lymphedema. Clinics in Plastic Surgery, 39, 377-384. https://doi.org/10.1016/j.cps.2012.08.001
[27] Lin, C.H., Ali, R., Chen, S.C., et al. (2009) Vascularized Groin Lymph Node Transfer Using the Wrist as a Recipient Site for Management of Postmastectomy Upper Extremity Lymphedema. Plastic & Reconstructive Surgery, 123, 1265- 1275. https://doi.org/10.1097/PRS.0b013e31819e6529
[28] Raju, A. and Chang, D.W. (2015) Vascularized Lymph Node Transfer for Treatment of Lymphedema: A Comprehensive Literature Review. Annals of Surgery, 261, 1013-1023. https://doi.org/10.1097/SLA.0000000000000763
[29] Dionyssiou, D., Demiri, E., Tsimponis, A., et al. (2016) A Randomized Control Study of Treating Secondary Stage II Breast Cancer-Related Lymphoedema with Free Lymph Node Transfer. Breast Cancer Research and Treatment, 156, 73-79. https://doi.org/10.1007/s10549-016-3716-0
[30] Pasko, J.L., Garreau, J., Carl, A., et al. (2015) Axillary Reverse Lymphatic Mapping Reduces Patient Perceived Incidence of Lymphedema after Axillary Dissection in Breast Cancer. The American Journal of Surgery, 209, 890-895. https://doi.org/10.1016/j.amjsurg.2015.01.011
[31] Yue, T., Zhuang, D., Zhou, P., et al. (2015) A Prospective Study to Assess the Feasibility of Axillary Reverse Mapping and Evaluate Its Effect on Preventing Lymphedema in Breast Cancer Patients. Clinical Breast Cancer, 15, 301-306. https://doi.org/10.1016/j.clbc.2015.01.010
[32] Dellachà, A., Boccardo, F., Zilli, A., Napoli, F., Fulcheri, E. and Campisi, C. (2000) Unexpected Histopathological Findings in Peripheral Lymphedema. Lymphology, 33, 62-64.
[33] Baumeister, R.G. and Siuda, S. (1990) Treatment of Lymphedemas by Microsurgical Lymphatic Grafting: What Is Proved? Plastic & Reconstructive Surgery, 85, 64-74. https://doi.org/10.1097/00006534-199001000-00012
[34] Torrisi, J.S., Joseph, W.J., Ghanta, S., et al. (2015) Lymphaticovenous Bypass Decreases Pathologic Skin Changes in Upper Extremity Breast Cancer-Related Lymphedema. Lymphatic Research and Biology, 13, 46-53. https://doi.org/10.1089/lrb.2014.0022
[35] Boccardo, F., Casabona, F., De Cian, F., et al. (2014) Lymphatic Microsurgical Preventing Healing Approach (LYMPHA) for Primary Surgical Prevention of Breast Cancer-Related Lymphedema: Over 4 Years Follow-Up. Microsurgery, 34, 421-424. https://doi.org/10.1002/micr.22254
[36] Campisi, C., Bellini, C., Campisi, C., Accogli, S., Bonioli, E. and Boccardo, F. (2010) Microsurgery for Lymphedema: Clinical Research and Long-Term Results. Microsurgery, 30, 256-260. https://doi.org/10.1002/micr.20737
[37] Olszewski, W.L. (2013) Lymphovenous Microsurgical Shunts in Treatment of Lymphedema of Lower Limbs: A 45-Year Experience of One Surgeon/One Center. European Journal of Vascular and Endovascular Surgery, 45, 282-290. https://doi.org/10.1016/j.ejvs.2012.11.025
[38] Masia, J., Olivares, L., Koshima, I., et al. (2014) Barcelona Consensus on Supermicrosurgery. Journal of Reconstructive Microsurgery, 30, 53-58. https://doi.org/10.1055/s-0033-1354742
[39] Chang, D.W. (2012) Lymphaticovenular Bypass Surgery for Lymphedema Management in Breast Cancer Patients. Handchirurgie•Mikrochirurgie•Plastische Chirurgie, 44, 343-347. https://doi.org/10.1055/s-0032-1323762
[40] Koshima, I., Narushima, M., Yamamoto, Y., Mihara, M. and Iida, T. (2012) Recent Advancement on Surgical Treatments for Lymphedema. Annals of Vascular Diseases, 5, 409-415. https://doi.org/10.3400/avd.ra.12.00080
[41] Yamamoto, T., Yoshimatsu, H., Narushima, M., et al. (2014) Sequential Anastomosis for Lymphatic Supermicrosurgery: Multiple Lymphaticovenular Anastomoses on Venule. Annals of Plastic Surgery, 73, 46-49. https://doi.org/10.1097/SAP.0b013e31826caff1
[42] Yamamoto, T., Narushima, M., Yoshimatsu, H., et al. (2014) Minimally Invasive Lymphatic Supermicrosurgery: Indocyanine Green Lymphography-Guided Simultaneous Multisite Lymphaticovenular Anastomoses via Millimeter Skin Incisions. Annals of Plastic Surgery, 72, 67-70. https://doi.org/10.1097/SAP.0b013e3182605580
[43] Mehrara, B.J., Zampell, J.C., Suami, H., et al. (2011) Surgical Management of Lymphedema: Past, Present, and Future. Lymphatic Research and Biology, 9, 159-167. https://doi.org/10.1089/lrb.2011.0011