乳腺癌术后皮下积液影响因素分析

发布时间：2018-05-25 15:45

本文选题：皮下积液 + 乳腺癌术后　；参考：《新乡医学院》2014年硕士论文

【摘要】：背景乳腺癌是女性最常见的恶性肿瘤之一,尽管我国在世界范围内的总体发病率偏低,但近年来有不断上升的趋势,对女性身体健康构成了严重威胁。随着社会经济发展和科学技术革新,乳腺癌的治疗手段日趋成熟和完善,而其中手术治疗是其中最为有效和显著的。但由于病患体质因素以及合并病症等影响,乳腺癌术后容易引起皮下积液的发生,严重影响病患术后恢复和进行综合治疗的有效时机,增加了术后复发转移的危险。目的探讨乳腺癌术后皮下积液产生的影响因素,探索减少皮下积液发生的有效途径,降低乳腺癌术后皮下积液的发生率。方法收集新乡医学院第一附属医院普外科2012年4月到2013年4月间乳腺癌连续性病例220例,病患均在本院行乳腺癌改良根治术或乳腺癌根治术治疗。采集病患相关临床资料,获取年龄、身高、体重、合并既往病史(高血压、糖尿病、冠心病、低蛋白血症等)、手术方式等基本信息；对病患进行术后临床观察,根据是否发生皮下积液,将220例病患分为比较组与对照组,比较组为术后发生皮下积液的病患,对照组为术后未发生皮下积液的病患。应用描述性统计分析描述病患基本特征；采用卡方检验(计数资料)或t检验(计量资料)进行双变量分析,比较两组病患相关基本特征；采用logistic回归分析筛选影响乳腺癌术后皮下积液产生的相关因素。结果通过统计分析对比,比较组与对照组患者年龄(p=0.002)、BMI(身体质量指数,下同；p=0.001)、合并高血压(p=0.023)、合并糖尿病(p=0.017)、合并低蛋白血症(p=0.004)具有统计学意义。而两组手术方式以及合并冠心病病史并没有产生显著性差异(p0.05)。可以认为比较组患者年龄较大,BMI较高,高血压、糖尿病、低蛋白血症合并病史较多。通过运用logistic逐步回归模型,筛选出皮下积液产生的主要危险因素,可以认为皮下积液的产生,与患者年龄(OR,1.10;95%CI,1.55-2.06)、BMI(OR,1.30;95%CI,1.05-2.33)、高血压(OR,1.15；95%CI,2.11-3.35)、糖尿病(OR,1.05；95%CI,1.17-4.22)、低蛋白血症(OR,1.23；95%CI,1.11-3.56)相关。与对照组患者相比,高龄、较高BMI、高血压、糖尿病和低蛋白血症合并病史均能导致乳腺癌术后皮下积液产生。结论乳腺癌术后皮下积液的发生与病患年龄、BMI、合并低蛋白血症、合并高血压、合并糖尿病等因素有关,而手术方式以及合并冠心病对皮下积液发生影响不大；通过围手术期减小身体质量指数、缓解合并病症等有助于减少术后皮下积液的发生。
[Abstract]:Background Breast cancer is one of the most common malignant tumors in women. Although the overall incidence of breast cancer in China is low in the world, there is a rising trend in recent years, which poses a serious threat to the health of women. With the development of social economy and the innovation of science and technology, the treatment of breast cancer is becoming more and more mature and perfect, among which surgical treatment is the most effective and significant. However, due to the influence of patients' physical condition and complicated diseases, the occurrence of subcutaneous effusion is easy to occur after operation of breast cancer, which seriously affects the effective time of postoperative recovery and comprehensive treatment, and increases the risk of postoperative recurrence and metastasis. Objective to explore the influencing factors of subcutaneous effusion after breast cancer operation, and to explore the effective way to reduce the incidence of subcutaneous effusion after breast cancer operation. Methods 220 consecutive cases of breast cancer were collected from April 2012 to April 2013 in the General surgery Department of the first affiliated Hospital of Xinxiang Medical College. All the patients were treated with modified radical mastectomy or radical mastectomy. To collect the clinical data of patients, obtain the basic information of age, height, weight, history (hypertension, diabetes, coronary heart disease, hypoproteinemia, etc.) According to the occurrence of subcutaneous effusion 220 patients were divided into two groups: the comparison group and the control group. The comparison group was the patient with postoperative subcutaneous effusion and the control group was the patient with no postoperative subcutaneous effusion. Descriptive statistical analysis was used to describe the basic characteristics of patients, and bivariate analysis was performed by chi-square test (counting data) or t-test (measurement data) to compare the basic characteristics of the two groups of patients. Logistic regression analysis was used to screen the factors related to subcutaneous effusion after breast cancer operation. Results by statistical analysis and comparison, the age of patients in the comparison group and the control group was significantly higher than that in the control group (body mass index (BMI), hypertension, diabetes mellitus, hypoproteinemia, and hypoproteinemia, respectively, P 0.001, P 0. 023, P 0. 017, P 0. 004). However, there was no significant difference between the two groups in the surgical methods and the history of coronary heart disease (P 0.05). It can be concluded that the patients in the comparison group have higher BMI, hypertension, diabetes and hypoproteinemia. By using the logistic stepwise regression model, the main risk factors for subcutaneous effusion were screened out. It can be concluded that the subcutaneous effusion is related to the patient's age, OR1.10 ~ 95CI1. 55-2. 06 BMIOR1. 3095CIQ 1.05-2.33, hypertension OR1. 1595CI2.11-3.35CI2.11-3.35, diabetes OR1.0595CI1. 17-4.22, hypoproteinemia OR1. 2395CI1. 11-3.56). Advanced age, high BMIs, hypertension, diabetes and hypoproteinemia combined with history all resulted in subcutaneous effusion after breast cancer surgery. Conclusion the occurrence of subcutaneous effusion after breast cancer operation is related to the age of patients with BMI, hypoproteinemia, hypertension and diabetes mellitus, but the operative method and coronary heart disease have little effect on the occurrence of subcutaneous effusion. The reduction of body mass index (BMI) during perioperative period and the relief of complications may help to reduce the incidence of postoperative subcutaneous effusion.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.9

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