乳腺癌术后疼痛综合征危险因素相关分析

发布时间：2018-11-15 14:49

【摘要】：乳腺癌是困扰女性的癌症之一,约90%的患者在治疗过程中会产生与治疗相关的并发症,此类并发症会在治疗后数月乃至数年持续存在,给患者的生活带来很大的困扰,严重影响其生活质量。通常手术是治疗乳腺癌的首选方法,乳腺癌术后疼痛综合征(PMPS)是发生在手术后的慢性疼痛,是乳房手术后最常见的并发症之一,其发病率在通过手术治疗乳腺癌的女性患者中可高达70%。PMPS的定义是:乳腺癌手术治疗后,超过正常组织愈合时间持续3个月以上的慢性病痛。主要表现为胸部、腋窝、手臂及肩背部等神经分布区域的感觉异常,并可能由于胸肩部运动而加剧,发病频率每星期4次及以上或每天超过12小时。PMPS被认为是一种神经病理性疼痛,其病因和发病机制尚不明确,目前的观点认为主要由于乳房切除术后对肋间臂神经的损伤而引起的神经痛,同时手术类型,特别是全腋窝淋巴结清扫(CAD)以及放疗、化疗、年龄、围手术期患者的处理、肿瘤的大小等均是影响该疾病发生的重要危险因素。目的:发达国家对PMPS的长期流行病学随访研究较多,国内对PMPS的影响因素尚未得到充分认识,相关研究调查较少。本研究选择2016年1月1日—2016年12月31日于吉林大学第二医院乳腺外科择期行乳腺手术的ASAI~III级女性乳腺癌患者作为调查研究对象,总结与PMPS相关的危险因素,进而指导临床治疗,判断预后。方法:选择2016年1月1日—2016年12月31日于吉林大学第二医院乳腺外科择期行乳腺癌手术的ASAI~III级女性患者。所有患者术后已经临床和病理均证实为乳腺癌,患者神志清楚,精神正常,无认知功能障碍,自愿接受调查并对诊断知情。原始病历需记载有肿瘤的大小、分期、腋窝淋巴结清扫情况、手术方式、术中所见及完整病理结果。剔除标准包括:肿瘤有局部或远处转移、患有肩周炎等关节炎或任何其他类型癌症、术后时间小于三个月者。预测变量(危险因素)包括:1.患者的生物学特征(体重指数BMI、年龄)2.既往任何类型的慢性疼痛(头痛和/或痛经)3.手术类型(乳腺癌改良根治术、保乳手术、是否行腋窝淋巴结清扫及淋巴结清扫个数)。统计学方法:发病情况与各因素的相关性分析:使用SPSS22.0进行变量相关统计学分析。1.计量资料:计量资料用均数±标准差(`X±SD)表示,两均数比较采用t检验(包括95%可信区间的计算),方差不齐时采用秩和检验。2.计数资料:计数资料采用X2检验。3.PMPS影响因素的分析:PMPS与危险因素关系的分析用Logistic回归分析前进法。结果:1.PMPS的流行病学特征:本实验共纳入203例女性乳腺癌患者进行研究,调查结果有3例失访,受访年龄26-78岁,平均年龄52.0±10.7岁。200例患者中,有70例(35%)出现了术后慢性疼痛,每名患者均行电话随访,受访患者一般统计情况见表3.1。70名患者中,疼痛持续时间从术后3个月至12个月不等,疼痛部位不仅仅只限于一个,有时会累及两个及两个以上部位,疼痛最好发部位是手术同侧腋窝(52例,74.3%),其余依次为手术同侧胸壁(31例,44.3%),手术同侧上臂(24例,34.3%)。疼痛性质多为麻木(36例,51.4%),其余依次为针刺样(29例,41.4%),过电样(7例,10%),灼烧样(5例,7.1%),一定比例的其他不适及疼痛(如无力、酸胀痛等)(4例,5.7%)。2.PMPS危险因素分析(1)单因素分析:单因素分析结果显示,在PMPS组与非PMPS组中差异有统计学意义的变量包括年龄、淋巴结清扫个数、术前慢性疼痛史。(见表3.2、表3.3)(2)二分类变量Logistic回归分析:将单因素分析影响较大的3个变量引入二分类变量Logistic回归分析,以0.05为入选水准,0.1为剔除标准。入选回归方程的变量仅有年龄。因此表明,在本研究中PMPS的发病过程中以年龄(小于50岁)对其影响较大,是PMPS的独立危险因素。(见表3.4、图3.1)
[Abstract]:Breast cancer is one of the cancers that afflict women, and about 90% of the patients will have complications associated with the treatment in the course of their treatment. Such complications may persist in the months or years of the treatment, causing great distress to the patient's life and seriously affecting their quality of life. General operation is the first choice for the treatment of breast cancer, and the post-operative pain syndrome (PMPS) is one of the most common complications following the operation of the breast, with a high incidence of up to 70% in women with breast cancer by surgery. The PMPS is defined as: After the operation of the breast cancer, the healing time of the normal tissue lasts for more than 3 months and the chronic pain is more than 3 months. The main performance is the sensory abnormality of the nerve distribution region such as the chest, the armpit, the arm and the back of the shoulder, and may be increased due to the movement of the chest and the shoulder, and the frequency of the onset is 4 times per week or more or more than 12 hours per day. PMPS is considered to be a neuropathic pain, and its causes and pathogenesis are not clear, and the current point of view is that it is mainly due to the neuralgia caused by the injury of the intercostal nerve after the mastectomy, while the type of operation, in particular all axillary lymph node dissection (CAD), and radiotherapy, The treatment of the patients with chemotherapy, age and perioperative period, the size of the tumor and so on are important risk factors that affect the occurrence of the disease. Objective: The long-term epidemiological follow-up of PMPS in developed countries is much higher, and the influence factors of PMPS are not fully recognized in China, and the relevant research is less. This study chose the ASAI ~ III female breast cancer patients who underwent breast surgery at the second hospital of Jilin University on January 1, 2016 as the subject of the investigation, and summarized the risk factors related to the PMPS, thus guiding the clinical treatment and judging the prognosis. Methods: From January 1, 2016 to the second hospital of Jilin University on December 31, 2016, the ASAI ~ III female patients undergoing breast cancer operation in the second hospital of Jilin University were selected. All patients had been clinically and pathologically proved to be breast cancer after operation, the patient was clear, the spirit was normal, there was no cognitive impairment, the investigation was voluntarily accepted and the diagnosis was informed. The original medical record shall be recorded with the size, stage, axillary lymph node dissection, operation mode, and complete pathological results of the tumor. The elimination criteria include local or distant metastasis of the tumor, arthritis or any other type of cancer, such as scapulohumeral periarthritis, with a post-operative time of less than three months. The predicted variables (risk factors) include: 1. The patient's biological characteristics (body mass index BMI, age) 2. Prior any type of chronic pain (headache and/ or dysmenorrhea) 3. Type of operation (modified radical operation of breast cancer, breast-protecting operation, whether axillary lymph node dissection and number of lymph node dissection should be performed). Statistical methods: The analysis of the correlation between the incidence and the factors: the statistical analysis of the variables was performed using the SPSS10.0. Measurement data: mean square standard deviation of measurement data ((X-SD) indicates that the comparison of the two mean is t-test (including the calculation of the 95% confidence interval), and the rank sum test is used when the variance is not the same. Count data: The count data is analyzed by the X2 test. 3. Analysis of the influence factors of PMPS: The analysis of the relationship between PMPS and the risk factors is analyzed by Logistic regression. Results: A total of 203 female breast cancer patients were enrolled in this experiment. The results showed that 3 cases were lost to follow-up. The age of the survey was 26-78 years. The average age was 52. 0%. The average age was 52. 0%. Among the 200 patients, 70 of the 200 patients (35%) had postoperative chronic pain. For each patient, a telephone follow-up was performed, and the general statistics for the patients surveyed were presented in Table 3.1. In 70 patients, the duration of pain ranged from 3 months to 12 months after operation, and the pain site was not limited to only one, and sometimes two or more sites were involved, The best part of the pain was the same side armpit (52 cases, 74.3%), the other was the same side wall of the operation (31 cases, 41.3%), and the upper arm of the same side (24 cases, 33.4%). The pain was numbness (36 cases, 51.4%), and the others were acupuncture (29 cases, 41.4%), electric samples (7 cases, 10%), burning samples (5 cases, 7.1%), some other discomfort and pain (such as weakness, The analysis of the risk factors of PMPS (4 cases, 5.7%) (4 cases, 5.7%). 2. The analysis of the risk factors of PMPS (1) The single factor analysis showed that the variables in the PMPS group and the non-PMPS group were statistically significant, including age, number of lymph node dissection, and history of chronic pain before operation. (2) Logistic regression analysis of two-class variables (see Table 3.2, Table 3. 3) (2): The univariate logistic regression analysis of three variables with a large influence on the single-factor analysis was introduced, with the inclusion level of 0. 05 and the exclusion criterion of 0.1. The variables that were included in the regression equation were only of age. Therefore, the influence of the age (less than 50 years) in the pathogenesis of the PMPS in this study was large and was an independent risk factor for the PMPS. (See Table 3.4, Figure 3.1)
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9

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