乳腺癌术后上肢淋巴水肿治疗的研究进展
Advances in the Treatment of Upper Limb Lymphedema after Breast Cancer Surgery
摘要: 乳腺癌相关淋巴水肿(Breast cancer-related lymphedema, BCRL)是乳腺癌(Breast cancer, BC)综合治疗后较为常见的淋巴系统并发症，也是乳腺癌患者全程管理中的重要组成部分，其临床表现主要为患肢疼痛、肿胀及皮肤结构改变。BCRL可严重影响患者的身心健康及生活质量，严重时可危及生命。因此有效预防BCRL并采取合理治疗措施具有重要意义。保守治疗是BCRL最主要的治疗方式，对于保守治疗无效的病人可采取手术治疗。本文就近年来BCRL的相关研究进行综述，主要探讨BCRL的发病原因、危险因素、诊断技术及治疗方法，为临床治疗提供参考，努力改善乳腺癌幸存者的生活质量。
Abstract: Breast cancer-related Iymphedema (BCRL) is a common complication of the lymphatic system after the comprehensive treatment of breast cancer (BC), and is also an important part of the overall management of breast cancer patients. The main clinical manifestations are extremity pain, swelling and skin structural changes. BCRL can seriously affect the physical and mental health and quality of life of patients, and can be life-threatening in severe cases. Therefore, it is of great significance to prevent BCRL effectively and take reasonable treatment measures. Conservative treatment is the most important treatment for BCRL, and surgical treatment can be adopted for patients who fail to respond to conservative treatment. In this paper, the relevant researches on BCRL in recent years are reviewed, mainly discussing the pathogenesis, risk factors, diagnostic techniques and treatment methods of BCRL, providing references for clinical treatment and trying to improve the quality of life of breast cancer survivors.
文章引用：苏彩艳. 乳腺癌术后上肢淋巴水肿治疗的研究进展[J]. 临床医学进展, 2024, 14(11): 1404-1413. https://doi.org/10.12677/acm.2024.14113026

参考文献

[1] Manrique, O.J., Bustos, S.S., Ciudad, P., Adabi, K., Chen, W.F., Forte, A.J., et al. (2022) Overview of Lymphedema for Physicians and Other Clinicians: A Review of Fundamental Concepts. Mayo Clinic Proceedings, 97, 1920-1935. [Google Scholar] [CrossRef] [PubMed]
[2] Matsui, C., Yamamoto, T., Tsukuura, R., Sakai, H., Miyazaki, T., Escandón, J.M., et al. (2022) Intraoperative Monitoring of Lymphatic Vessel Characteristics Using Video‐Capillaroscopy in the Procedure of Lymphaticovenular Anastomosis. Microsurgery, 42, 850-851. [Google Scholar] [CrossRef] [PubMed]
[3] DiSipio, T., Rye, S., Newman, B. and Hayes, S. (2013) Incidence of Unilateral Arm Lymphoedema after Breast Cancer: A Systematic Review and Meta-Analysis. The Lancet Oncology, 14, 500-515. [Google Scholar] [CrossRef] [PubMed]
[4] Wyld, L., Markopoulos, C., Leidenius, M. and Senkus-Konefka, E. (2018) Breast Cancer Management for Surgeons: A European Multidisciplinary Textbook. Springer International Publishing. [Google Scholar] [CrossRef] 
[5] Ciudad, P., Escandón, J.M., Manrique, O.J., Gutierrez‐Arana, J. and Mayer, H.F. (2022) Lymphedema Prevention and Immediate Breast Reconstruction with Simultaneous Gastroepiploic Vascularized Lymph Node Transfer and Deep Inferior Epigastric Perforator Flap: A Case Report. Microsurgery, 42, 617-621. [Google Scholar] [CrossRef] [PubMed]
[6] Mackenzie, C.D., Kapa, D.R., Krishnasastry, S., Douglass, J., Hoerauf, A. and Ottesen, E.A. (2024) Managing Lymphedema Induced by Lymphatic Filariasis: Implementing and Improving Care at the Individual and Programmatic Levels. The American Journal of Tropical Medicine and Hygiene, 111, 3-21. [Google Scholar] [CrossRef] [PubMed]
[7] Marchica, P., D’Arpa, S., Magno, S., Rossi, C., Forcina, L., Capizzi, V., et al. (2021) Integrated Treatment of Breast Cancer-Related Lymphedema: A Descriptive Review of the State of the Art. Anticancer Research, 41, 3233-3246. [Google Scholar] [CrossRef] [PubMed]
[8] Libson, S. and Lippman, M. (2014) A Review of Clinical Aspects of Breast Cancer. International Review of Psychiatry, 26, 4-15. [Google Scholar] [CrossRef] [PubMed]
[9] Kilbreath, S.L., Refshauge, K.M., Beith, J.M., Ward, L.C., Ung, O.A., Dylke, E.S., et al. (2016) Risk Factors for Lymphoedema in Women with Breast Cancer: A Large Prospective Cohort. The Breast, 28, 29-36. [Google Scholar] [CrossRef] [PubMed]
[10] Chowdhry, M., Rozen, W.M. and Griffiths, M. (2016) Lymphatic Map and Preoperative Imaging in the Management of Post-Mastectomy Lymphoedema. Gland Surgery, 5, 187-196. [Google Scholar] [CrossRef] 
[11] Marco, E., Trépanier, G., Chang, E., Mauti, E., Jones, J.M. and Zhong, T. (2023) Postmastectomy Functional Impairments. Current Oncology Reports, 25, 1445-1453. [Google Scholar] [CrossRef] [PubMed]
[12] Shah, C. and Vicini, F.A. (2011) Breast Cancer-Related Arm Lymphedema: Incidence Rates, Diagnostic Techniques, Optimal Management and Risk Reduction Strategies. International Journal of Radiation Oncology∙Biology∙Physics, 81, 907-914. [Google Scholar] [CrossRef] [PubMed]
[13] Kuruvilla, A.S., Krajewski, A., Li, X., Yang, J., Mulay, S.R., Agha, S.M., et al. (2022) Risk Factors Associated with Postmastectomy Breast Cancer Lymphedema: A Multicenter Retrospective Analysis. Annals of Plastic Surgery, 88, S239-S245. [Google Scholar] [CrossRef] [PubMed]
[14] Tait, R.C., Zoberi, K., Ferguson, M., Levenhagen, K., Luebbert, R.A., Rowland, K., et al. (2018) Persistent Post-Mastectomy Pain: Risk Factors and Current Approaches to Treatment. The Journal of Pain, 19, 1367-1383. [Google Scholar] [CrossRef] [PubMed]
[15] Koelmeyer, L.A., Gaitatzis, K., Dietrich, M.S., Shah, C.S., Boyages, J., McLaughlin, S.A., et al. (2022) Risk Factors for Breast Cancer-Related Lymphedema in Patients Undergoing 3 Years of Prospective Surveillance with Intervention. Cancer, 128, 3408-3415. [Google Scholar] [CrossRef] [PubMed]
[16] Shen, A., Qiang, W., Zhang, L., Bian, J., Zhu, F., Zhang, Z., et al. (2023) Risk Factors for Breast Cancer-Related Lymphedema: An Umbrella Review. Annals of Surgical Oncology, 31, 284-302. [Google Scholar] [CrossRef] [PubMed]
[17] Tomić, S., Malenković, G., Mujičić, E., Šljivo, A. and Tomić, S.D. (2024) Impact of Risk Factors, Early Rehabilitation and Management of Lymphedema Associated with Breast Cancer: A Retrospective Study of Breast Cancer Survivors over 5 Years. BMC Women’s Health, 24, Article No. 226. [Google Scholar] [CrossRef] [PubMed]
[18] Varman, B., Yılmaz, H., Eryılmaz, M.A., Muştu, Y.B. and Varman, A. (2024) Functional Status, Depression, and Quality of Life in Female Patients with Postmastectomy Lymphedema. European Surgery, 56, 33-38. [Google Scholar] [CrossRef] 
[19] McLaughlin, S.A., Brunelle, C.L. and Taghian, A. (2020) Breast Cancer-Related Lymphedema: Risk Factors, Screening, Management, and the Impact of Locoregional Treatment. Journal of Clinical Oncology, 38, 2341-2350. [Google Scholar] [CrossRef] [PubMed]
[20] Asdourian, M.S., Skolny, M.N., Brunelle, C., Seward, C.E., Salama, L. and Taghian, A.G. (2016) Precautions for Breast Cancer-Related Lymphoedema: Risk from Air Travel, Ipsilateral Arm Blood Pressure Measurements, Skin Puncture, Extreme Temperatures, and Cellulitis. The Lancet Oncology, 17, e392-e405. [Google Scholar] [CrossRef] [PubMed]
[21] Vignes, S., Poizeau, F. and Dupuy, A. (2022) Cellulitis Risk Factors for Patients with Primary or Secondary Lymphedema. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 10, 179-185.E1. [Google Scholar] [CrossRef] [PubMed]
[22] Gillespie, T.C., Sayegh, H.E., Brunelle, C.L., Daniell, K.M. and Taghian, A.G. (2018) Breast Cancer-Related Lymphedema: Risk Factors, Precautionary Measures, and Treatments. Gland Surgery, 7, 379-403. [Google Scholar] [CrossRef] [PubMed]
[23] Executive Committee (2016) The Diagnosis and Treatment of Peripheral Lymphedema: 2016 Consensus Document of the International Society of Lymphology. Lymphology, 49, 170-184.
[24] He, L., Qu, H., Wu, Q. and Song, Y. (2020) Lymphedema in Survivors of Breast Cancer (Review). Oncology Letters, 19, 2085-2096. [Google Scholar] [CrossRef] [PubMed]
[25] Anderson, E.A. and Armer, J.M. (2021) Factors Impacting Management of Breast Cancer-Related Lymphedema (BCRL) in Hispanic/Latina Breast Cancer Survivors: A Literature Review. Hispanic Health Care International, 19, 190-202. [Google Scholar] [CrossRef] [PubMed]
[26] Soran, A., Polat, A.K. and Mager, L.G. (2016) Breast Cancer-Related Lymphedema (BCRL). In: Aydiner, A., İgci, A. and Soran, A., Eds., Breast Disease, Springer International Publishing, 853-876. [Google Scholar] [CrossRef] 
[27] Yamamoto, T., Ogata, F., Yoshimatsu, H., Mihara, M., Koshima, I. and Narushima, M. (2015) Indocyanine Green Lymphography Findings in Limb Lymphedema. Journal of Reconstructive Microsurgery, 32, 72-79. [Google Scholar] [CrossRef] [PubMed]
[28] Yamamoto, T., Narushima, M., Yoshimatsu, H., Yamamoto, N., Kikuchi, K., Todokoro, T., et al. (2014) Dynamic Indocyanine Green (ICG) Lymphography for Breast Cancer-Related Arm Lymphedema. Annals of Plastic Surgery, 73, 706-709. [Google Scholar] [CrossRef] [PubMed]
[29] Abbaci, M., Conversano, A., De Leeuw, F., Laplace-Builhé, C. and Mazouni, C. (2019) Near-Infrared Fluorescence Imaging for the Prevention and Management of Breast Cancer-Related Lymphedema: A Systematic Review. European Journal of Surgical Oncology, 45, 1778-1786. [Google Scholar] [CrossRef] [PubMed]
[30] Hassanein, A.H., Maclellan, R.A., Grant, F.D. and Greene, A.K. (2017) Diagnostic Accuracy of Lymphoscintigraphy for Lymphedema and Analysis of False-Negative Tests. Plastic and Reconstructive Surgery-Global Open, 5, e1396. [Google Scholar] [CrossRef] [PubMed]
[31] Ter, S., Alavi, A., Kim, C.K. and Merli, G. (1993) Lymphoscintigraphy a Reliable Test for the Diagnosis of Lymphedema. Clinical Nuclear Medicine, 18, 646-654. [Google Scholar] [CrossRef] [PubMed]
[32] Dori, Y., Zviman, M.M. and Itkin, M. (2014) Dynamic Contrast-Enhanced MR Lymphangiography: Feasibility Study in Swine. Radiology, 273, 410-416. [Google Scholar] [CrossRef] [PubMed]
[33] Bordonaro, V., Ciancarella, P., Ciliberti, P., Curione, D., Napolitano, C., Santangelo, T.P., et al. (2021) Dynamic Contrast-Enhanced Magnetic Resonance Lymphangiography in Pediatric Patients with Central Lymphatic System Disorders. La radiologia medica, 126, 737-743. [Google Scholar] [CrossRef] [PubMed]
[34] Ramirez-Suarez, K.I., Tierradentro-Garcia, L.O., Smith, C.L., et al. (2022) Dynamic Contrast-Enhanced Magnetic Resonance Lymphangiography. Pediatric Radiology, 52, 285-294. [Google Scholar] [CrossRef] [PubMed]
[35] Kerrigan, C.B., Ahern, T.P., Brennan, S.K., Kurchena, K.C., Nelson, C.J. and Sowden, M.M. (2021) Ultrasound for the Objective Measurement of Breast Lymphedema. Journal of Ultrasound in Medicine, 41, 1993-2002. [Google Scholar] [CrossRef] [PubMed]
[36] Güvener, O., Ricci, V. and Özçakar, L. (2022) The Mounting Role of Ultrasound Examination in Lymphedema Evaluation. Journal of Plastic, Reconstructive & Aesthetic Surgery, 75, 893-939. [Google Scholar] [CrossRef] [PubMed]
[37] Brandão, M.L., Soares, H.P.S., Andrade, M.A., et al. (2020) Efficacy of Complex Decongestive Therapy for Lymphedema of the Lower Limbs: A Systematic Review. Journal Vascular Brasileiro, 19, e20190074.
[38] Shamoun, S. and Ahmad, M. (2023) Complete Decongestive Therapy Effect on Breast Cancer Related to Lymphedema: A Systemic Review and Meta-Analysis of Randomized Controlled Trials. Asian Pacific Journal of Cancer Prevention, 24, 2225-2238. [Google Scholar] [CrossRef] [PubMed]
[39] Takeno, Y., Arita, H. and Fujimoto, E. (2013) Efficacy of Complete Decongestive Therapy (CDT) on Edematous Rat Limb after Lymphadenectomy Demonstrated by Real Time Lymphatic Fluid Tracing. SpringerPlus, 2, Article No. 225. [Google Scholar] [CrossRef] [PubMed]
[40] Zaleska, M.T. and Olszewski, W.L. (2020) Tissue Structure and Edema Fluid Events during Treatment of Lymphedema of Limbs with a Manual Pressure-Calibrated Device, Linforoll. Lymphatic Research and Biology, 18, 35-41. [Google Scholar] [CrossRef] [PubMed]
[41] Hara, H., Yoshida, M., Ikehata, N., Tachibana, S., Hamanaka, N., Nakakawaji, K., et al. (2021) Compression Pressure Variability in Upper Limb Multilayer Bandaging Applied by Lymphedema Therapists. Lymphatic Research and Biology, 19, 378-382. [Google Scholar] [CrossRef] [PubMed]
[42] Li, K., Zhang, Z., Liu, N.F., Sadigh, P., Evans, V.J., Zhou, H., et al. (2018) Far-Infrared Radiation Thermotherapy Improves Tissue Fibrosis in Chronic Extremity Lymphedema. Lymphatic Research and Biology, 16, 248-257. [Google Scholar] [CrossRef] [PubMed]
[43] Borman, P. (2018) Lymphedema Diagnosis, Treatment, and Follow-Up from the View Point of Physical Medicine and Rehabilitation Specialists. Turkish Journal of Physical Medicine and Rehabilitation, 64, 179-197. [Google Scholar] [CrossRef] [PubMed]
[44] Tran, K. and Argáez, C. (2018) Intermittent Pneumatic Compression Devices for the Management of Lymphedema: A Review of Clinical Effectiveness and Guidelines. Canadian Agency for Drugs and Technologies in Health.
[45] Uzkeser, H., Karatay, S., Erdemci, B., Koc, M. and Senel, K. (2013) Efficacy of Manual Lymphatic Drainage and Intermittent Pneumatic Compression Pump Use in the Treatment of Lymphedema after Mastectomy: A Randomized Controlled Trial. Breast Cancer, 22, 300-307. [Google Scholar] [CrossRef] [PubMed]
[46] Yamamoto, T., Yoshimatsu, H., Yamamoto, N., Narushima, M., Iida, T. and Koshima, I. (2013) Side-to-End Lymphaticovenular Anastomosis through Temporary Lymphatic Expansion. PLOS ONE, 8, e59523. [Google Scholar] [CrossRef] [PubMed]
[47] Yamamoto, T., Fisher, M., Liao, J., Carr, J. and Chen, W. (2015) The “Octopus” Lymphaticovenular Anastomosis: Evolving Beyond the Standard Supermicrosurgical Technique. Journal of Reconstructive Microsurgery, 31, 450-457. [Google Scholar] [CrossRef] [PubMed]
[48] Chang, D.W. (2010) Lymphaticovenular Bypass for Lymphedema Management in Breast Cancer Patients: A Prospective Study. Plastic and Reconstructive Surgery, 126, 752-758. [Google Scholar] [CrossRef] [PubMed]
[49] Ciudad, P., Huayllani, M.T., Forte, A.J., Boczar, D., Avila, F.R., Escandón, J.M., et al. (2022) Vascularized Lymph Node Transfer for the Treatment of Posttraumatic Lower Extremity Lymphedema: A Preliminary Report. Indian Journal of Plastic Surgery, 55, 097-101. [Google Scholar] [CrossRef] [PubMed]
[50] Cheng, M., Huang, J., Nguyen, D.H., Saint-Cyr, M., Zenn, M.R., Tan, B.K., et al. (2012) A Novel Approach to the Treatment of Lower Extremity Lymphedema by Transferring a Vascularized Submental Lymph Node Flap to the Ankle. Gynecologic Oncology, 126, 93-98. [Google Scholar] [CrossRef] [PubMed]
[51] Becker, C., Assouad, J., Riquet, M. and Hidden, G. (2006) Postmastectomy Lymphedema: Long-Term Results Following Microsurgical Lymph Node Transplantation. Annals of Surgery, 243, 313-315. [Google Scholar] [CrossRef] [PubMed]
[52] Lin, C., Ali, R., Chen, S., Wallace, C., Chang, Y., Chen, H., et al. (2009) Vascularized Groin Lymph Node Transfer Using the Wrist as a Recipient Site for Management of Postmastectomy Upper Extremity Lymphedema. Plastic and Reconstructive Surgery, 123, 1265-1275. [Google Scholar] [CrossRef] [PubMed]
[53] Schaverien, M.V. and Coroneos, C.J. (2019) Surgical Treatment of Lymphedema. Plastic & Reconstructive Surgery, 144, 738-758. [Google Scholar] [CrossRef] [PubMed]
[54] Doscher, M.E., Herman, S. and Garfein, E.S. (2012) Surgical Management of Inoperable Lymphedema: The Re-Emergence of Abandoned Techniques. Journal of the American College of Surgeons, 215, 278-283. [Google Scholar] [CrossRef] [PubMed]
[55] Chang, T.S., Han, L.Y., Gan, J.L., et al. (1989) Microwave: An Alternative to Electric Heating in the Treatment of Peripheral Lymphedema. Lymphology, 22, 20-24.
[56] Hasenoehrl, T., Palma, S., Ramazanova, D., Kölbl, H., Dorner, T.E., Keilani, M., et al. (2020) Resistance Exercise and Breast Cancer-Related Lymphedema—A Systematic Review Update and Meta-Analysis. Supportive Care in Cancer, 28, 3593-3603. [Google Scholar] [CrossRef] [PubMed]
[57] Brorson, H. (2015) Liposuction in Lymphedema Treatment. Journal of Reconstructive Microsurgery, 32, 56-65. [Google Scholar] [CrossRef] [PubMed]
[58] Brorson, H. (2003) Liposuction in Arm Lymphedema Treatment. Scandinavian Journal of Surgery, 92, 287-295. [Google Scholar] [CrossRef] [PubMed]

为你推荐