乳腺浸润性导管癌术后上肢淋巴水肿的危险因素分析和临床防治探讨

发布时间：2018-05-31 01:15

本文选题：浸润性导管癌 + 上肢淋巴水肿　；参考：《山东中医药大学》2017年硕士论文

【摘要】：研究目的:本研究通过回访乳腺浸润性导管癌术后患者临床资料,分析并探讨有关患侧上肢淋巴水肿的危险因素、发病机制以及治疗策略,为乳腺浸润性导管癌术后上肢淋巴水肿的治疗提供可靠的临床依据。研究方法:1.收集2015年1月1日至2016年12月30日山东中医药大学附属医院肿瘤科门诊及病房接受治疗的乳腺浸润性导管癌患者临床资料,了解术后淋巴水肿发生情况。2.制定回访表格,回访记录患者手术、术后、治疗、水肿、转归和预后等情况,根据研究目的进行统计分析和探讨。3.分析李秀荣教授的治疗经验探讨乳腺浸润性导管癌术后上肢淋巴水肿的相关危险因素、发病机制以及预后情况,以求为临床治疗策略提供理论基础。研究结果:通过对92例乳腺浸润性导管癌术后患者的研究表明:1.术后发生上肢淋巴水肿者32例(水肿组,占34%),术后未发生上肢淋巴水肿者60例(非水肿组,占66%);两组在年龄、BMI指数、内分泌治疗、术后放疗、术后感染分布中具有统计学差异(P0.05)。2.logistic回归分析表明:与浸润性导管癌术后上肢淋巴水肿有关系的因素为:年龄、BMI指数、感染及放疗。3.危险因素越少,患者水肿程度越轻,水肿分期越低;危险因素越多,患者的水肿程度越重,水肿分期越高。4.临床上乳腺浸润性导管癌术后上肢淋巴水肿以中度水肿较为常见,中医药对于防治中度水肿具有一定优势。研究结论:1.除手术必然性因素外,乳腺浸润性导管癌术后上肢淋巴水肿的主要危险因素是高龄、肥胖、感染及放疗,有效控制体重以及预防感染对于防治乳腺浸润性导管癌术后上肢淋巴水肿具有积极作用。2.“虚”、“瘀”、“湿”不仅与“蛋白沉积”“脂肪沉积”“纤维化”等病理改变相关,同时也是推动淋巴水肿发展的病理产物。“健脾利湿”和“活血化瘀”是防治乳腺浸润性导管癌术后上肢淋巴水肿的基本原则,从“虚”“瘀”“湿”着手,应用中药防治乳腺浸润性导管癌术后上肢淋巴水肿具有重大意义。
[Abstract]:Objective: to investigate the risk factors, pathogenesis and treatment strategy of lymphedema in the upper extremity of breast cancer patients after breast invasive ductal carcinoma surgery. To provide a reliable clinical basis for the treatment of upper limb lymphedema after breast invasive ductal carcinoma. Research method: 1. From January 1, 2015 to December 30, 2016, the clinical data of breast invasive ductal carcinoma patients treated in the oncology department of affiliated Hospital of Shandong University of traditional Chinese Medicine were collected to understand the incidence of lymphedema after operation. Make a return visit form, record the operation, postoperative, treatment, edema, outcome and prognosis of patients, according to the purpose of the study statistical analysis and discussion. 3. To explore the risk factors, pathogenesis and prognosis of lymphedema in upper extremity after operation of invasive ductal carcinoma of breast, and to provide a theoretical basis for clinical treatment. Study results: 92 patients with invasive ductal carcinoma of the breast after surgery showed that: 1. 1. There were 32 cases of upper limb lymphedema (edema group, 34 cases) and 60 cases of no upper limb lymphedema (non-edema group, 66%). Logistic regression analysis showed that the factors associated with upper limb lymphedema after operation for invasive ductal carcinoma were age BMI index, infection and radiotherapy. The less risk factors, the lighter the degree of edema, the lower the stage of edema, and the more risk factors, the more serious the degree of edema, the higher the stage of edema. 4. Moderate edema is common in upper limb lymphedema after operation of invasive ductal carcinoma of breast. Chinese medicine has some advantages in preventing and treating moderate edema. Conclusion: 1. In addition to surgical necessity, the main risk factors for upper limb lymphedema after breast invasive ductal carcinoma surgery were old age, obesity, infection and radiotherapy. Effective control of body weight and prevention of infection in the prevention and treatment of breast invasive ductal carcinoma after the upper limb lymphedema has a positive role. "deficiency", "stasis" and "dampness" are not only related to the pathological changes such as "protein deposition", "fat deposition" and "fibrosis", but also the pathological products that promote the development of lymphedema. "invigorating spleen and promoting dampness" and "promoting blood circulation and removing blood stasis" are the basic principles of preventing and treating upper limb lymphedema after operation of invasive ductal carcinoma of mammary glands, starting with "deficiency", "stasis" and "dampness". It is of great significance to prevent and treat upper limb lymphedema after operation of breast invasive ductal carcinoma with Chinese medicine.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9

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