摘要
目的对比研究腋窝反向作图(Axillary reserve mapping,ARM)和创面应用透明质酸钠(Hyaluronic acid,HA)对乳腺癌相关上肢淋巴水肿预防效果。方法 106例有手术指征的女性乳腺癌患者,均为单侧、非晚期,随机分为腋窝反向淋巴作图同时应用透明质酸钠组(ARM+HA组,n=33)、单纯腋窝反向淋巴作图组(ARM组,n=28)、传统方式腋窝淋巴结廓清组(对照组,n=45),术后6~8个月随访检查局部肢体感觉情况,是否合并上肢淋巴水肿及程度。结果ARM可使上肢淋巴引流在腋窝处蓝染,行腋窝淋巴结清扫(Axillary lymph nodes dissection,ALND)时避免损伤。ARM+HA组肢体局部感觉异常例数少于ARM组和对照组,差异有统计学意义(P<0.05),只有约18.2%患者出现。ARM+HA组和ARM组术后上肢淋巴水肿发生例数均少于对照组,差异有统计学意义(P<0.05),而ARM+HA组和ARM组之间比较,差异无统计学意义(P>0.05)。结论 ARM可有效预防乳腺癌相关上肢淋巴水肿的发生,加用HA与否并不影响ARM的预防效果。但是,创面应用HA有助减少局部肢体感觉异常的发生。更长期的效果,需要更多的临床数据支持。
Objective To contrastively study the effect of axillary reserve mapping（ Axillary reserve mapping, ARM）and application of Hyaluronic acid （ Hyaluronic acid, HA） in the wound on the prevention of upper extremity lymphedema associated with breast cancer. Methods 106 cases of female breast cancer patients with surgical indications,of which the breast cancer was unilateral and non-advanced, were randomly divided into axillary reserve mapping and application of hyaluronic acid group （ARM ＋ HA group,n = 33 ） , simple axillary reverse mapping group （ARM group, n = 28 ） , group of axillary lymph node dissection by the traditional way （eantrol group, n = 45 ）. 6-8 months after the operation, patients were followed up to cheek the local limb sensation ,whether the up- per extremity lymphedema was complicated and its degree. Results ARM could make the upper limb lymph drainage blue in armpit, and we should avoid to injury it while doing axillary lymph node dissection（ Axillary lymph nodes dissection, ALND）. The number of pa- tients with limb paresthesia in ARM ＋ HA groupwas less than that in ARM group and control group （P 〈 0.05 ）, and only about 18. 2% of patients appeared. The number of upper limb lymphedema after surgery in ARM ＋ HA group and ARM group was both less than that in control group, and the difference was statistically significant （P 〈 0. 05 ）. However, there was no significant difference between ARM ＋ HA group and ARM group （P 〉 0. 05 ）. Conclusion ARM can effectively prevent the occurrence of upper limb lymphedema associated with breast cancer,and the effect of ARM is not affected by the addition of HA. However,the application of HA in the wound is helptial to reduce the occurrence of local limb paresthesia. And more long-term results require the support of more clinical data.
出处
《四川医学》
CAS
2017年第6期639-642,共4页
Sichuan Medical Journal
基金
佛山市医学类科技攻关项目(编号:2016AB001264)
