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1.
Arm lymphedema develops in 10%-35% of patients who undergo axillary dissection and/or nodal radiation therapy for breast cancer. Lymphedema that occurs in the first 18 months after surgery or radiation is described as acute lymphedema, and can be managed with conservative measures such as elevation of the arm and mild compression. Chronic lymphedema, the more serious form, has a progressive and generally irreversible course. Risk factors associated with the development of lymphedema include greater extent of axillary surgery; more positive axillary nodes; a postoperative axillary hematoma, seroma, or infection; and use of nodal radiation.The most common method of lymphedema measurement is the circumference 10 cm above and below the olecranon process, although most clinicians do not take measurements in the preoperative setting for comparison.Treatment strategies include elevation, complete decongestive physiotherapy, pneumatic pumps, and, after failure of all other methods, surgery. Lymphangiosarcoma is a rare and late complication of longstanding extremity lymphedema.The advent of sentinel lymph node biopsy as an alternative to axillary dissection should decrease the rate of lymphedema.The increasing number of breast cancer survivors and the high prevalence of the disease will continue to make lymphedema a significant consequence of breast cancer treatment. 相似文献
2.
目的探讨护理干预对控制乳腺癌手术后淋巴水肿发生的作用。方法采用历史对照研究,选取64名拟接受乳腺癌改良根治术的患者为实验组,对实验组患者提供电话随访和淋巴水肿自我行为管理指导的护理干预。另选60例非同期相同手术方式乳腺癌患者为对照组,对淋巴水肿的发生情况做历史对照。结果实验组患者淋巴水肿发生率低于历史对照组,差异有统计学意义(Х^2=4.75,P〈0.05)。结论对乳癌患者在淋巴水肿亚临床期给予护理干预,可以控制淋巴水肿的发生,电话随访、自我管理手册可以促进乳腺癌术后患者淋巴水肿的自我行为管理。 相似文献
3.
CL Miller MC Specht MN Skolny LS Jammallo N Horick J O'Toole SB Coopey K Hughes M Gadd BL Smith AG Taghian 《Breast cancer research and treatment》2012,135(3):781-789
Women diagnosed with or at high risk for breast cancer increasingly choose prophylactic mastectomy. It is unknown if adding sentinel lymph node biopsy (SLNB) to prophylactic mastectomy increases the risk of lymphedema. We sought to determine the risk of lymphedema after mastectomy with and without nodal evaluation. 117 patients who underwent bilateral mastectomy were prospectively screened for lymphedema. Perometer arm measurements were used to calculate weight-adjusted arm volume change at each follow-up. Of 234 mastectomies performed, 15.8?% (37/234) had no axillary surgery, 63.7?% (149/234) had SLNB, and 20.5?% (48/234) had axillary lymph node dissection (ALND). 88.0?% (103/117) of patients completed the LEFT-BC questionnaire evaluating symptoms associated with lymphedema. Multivariate analysis was used to assess clinical characteristics associated with increased weight-adjusted arm volume and patient-reported lymphedema symptoms. SLNB at the time of mastectomy did not result in an increased mean weight-adjusted arm volume compared to mastectomy without axillary surgery (p?=?0.76). Mastectomy with ALND was associated with a significantly greater mean weight-adjusted arm volume change compared to mastectomy with SLNB (p?0.0001) and without axillary surgery (p?=?0.0028). Patients who underwent mastectomy with ALND more commonly reported symptoms associated with lymphedema compared to those with SLNB or no axillary surgery (p?0.0001). Patients who underwent mastectomy with SLNB or no axillary surgery reported similar lymphedema symptoms. Addition of SLNB to mastectomy is not associated with a significant increase in measured or self-reported lymphedema rates. Therefore, SLNB may be performed at the time of prophylactic mastectomy without an increased risk of lymphedema. 相似文献
4.
《Current problems in cancer》2020,44(4):100538
Lymphedema is a common complication following oncologic surgeries and is classically described to occur months to a few years after these procedures. A 64 year-old woman with history of total abdominal hysterectomy and bilateral salpingo-oophorectomy developed right-sided lower extremity lymphedema 7 years after the surgeries. Lymphographic imaging performed approximately twenty years after the original surgeries revealed development of subclinical, asymptomatic lymphedema on the contralateral lower extremity. This delayed presentation of lymphedema after initial injury, is the first described case of subclinical lymphedema without detectable lymphatic injury, making it important to continuously monitor patients at risk for lymphedema long-term. 相似文献
5.
Hinrichs CS Gibbs JF Driscoll D Kepner JL Wilkinson NW Edge SB Fassl KA Muir R Kraybill WG 《Journal of surgical oncology》2004,85(4):187-192
OBJECTIVE: Groin dissection is performed for the treatment of melanoma and other malignancies. Lymphedema rates as high as 47% have been reported. In 1996, we began using complete decongestive physiotherapy (CDP) in selected patients with lymphedema following groin dissection. Here, we review our results in a small cohort of patients. METHODS: A retrospective review of the medical records of 14 patients, treated with CDP for lymphedema secondary to groin dissection for melanoma was conducted. All patients were treated with CDP at Roswell Park Cancer Institute (RPCI), between 1996 and 2002. Of the 14 patients, 12 underwent groin dissection at RPCI. Response to therapy was measured by limb volume determinations. Patient gender, age, body mass index (BMI), type of operation, type of adjuvant therapy, time to treatment, patient compliance, lymphedema stage, and initial edema were analyzed for association with response to treatment. Incidence was estimated by a review of the operative logs. RESULTS: Fourteen patients were treated with CDP for lymphedema secondary to groin dissection for melanoma, with a median decrease in lymphedema of 60% (range: 35-145%; P = 0.0003). Increased BMI was associated with a decreased response to treatment (P = 0.02). Response to CDP was not effected by time to treatment, patient compliance, lymphedema stage, and initial edema. During this time, 39 groin dissections were done at RPCI. The incidence of lymphedema treated with CDP at RPCI was 31% (12/39; standard error 7.4%). CONCLUSIONS: With a decrease in lymphedema of 60%, CDP may provide relief for patients with lymphedema following groin dissection. Elevated BMI was associated with a decreased response to CDP. 相似文献
6.
Yamamoto R Yamamoto T 《International journal of clinical oncology / Japan Society of Clinical Oncology》2007,12(6):463-468
Background Complex decongestive physiotherapy (CDP) consists of a two-phase treatment program and is the international standard therapy
for lymphedema. However, this therapy is not performed at most hospitals in Japan.
Methods The subjects of the present study were 82 Japanese women with lymphedema of an extremity (median age, 64 years; range, 40–86
years). The volume of the affected extremity was compared before and after therapy, and the duration of the CDP treatment
phase and rate of edema reduction were ascertained. The associations between the effect of CDP and duration of lymphedema,
operative procedure, and radiotherapy were also investigated.
Results For patients with upper-extremity lymphedema, the median duration of the CDP treatment phase was 6 treatment days (range,
3–26 days), median reduction of edema volume was 328.7 ml (range, 76.6–1258.0 ml; P = 0.0014), and median rate of edema reduction was 58.9% (range, 42.7%–97.1%). For patients with lower-extremity lymphedema,
the median duration of the CDP treatment phase was 10 treatment days (range, 2–35 days), median reduction of edema volume
was 1573.7 ml (range, 293.9–3471.1 ml; P < 0.0001), and median rate of edema reduction was 73.4% (range, 29.2%–117.3%). Although no correlation was seen between duration
of lymphedema and duration of the CDP treatment phase or rate of edema reduction, the degree of lymph node dissection tended
to influence rate of edema reduction in patients with lower-extremity lymphedema.
Conclusion In a study of Japanese women with lymphedema, CDP comprising a two-phase treatment program was clearly effective. 相似文献
7.
《Clinical breast cancer》2022,22(6):553-559
BackgroundBreast cancer-related lymphedema can significantly compromise quality of life. Bioimpedance spectroscopy (BIS) measures extracellular fluid in lymphedema. The purpose of this study was to determine the incidence of BIS-detected lymphedema using the L-Dex and identify risk factors associated with a positive score.Materials and MethodsWe performed a retrospective review of our institutional database to identify patients who underwent L-Dex U400 measurements. Patients with a score of > 10 L-Dex units or with an increase of > 10 units from baseline had a positive score. Clinical lymphedema was determined by documentation in the chart at the time of positive measurement. Otherwise, patients were considered to have subclinical lymphedema.ResultsFifty-three patients met study criteria. Thirty patients (56.6%) underwent mastectomy, 22 (41.5%) axillary lymph node dissection (ALND), and 33 (62.3%) received radiation (RT). Twelve patients (22.6%) had a positive score. There were no differences in age, race, laterality, breast surgery, T stage, N stage, chemotherapy, or RT fields (none, breast only, breast with LNs) in patients with a positive score. ALND was more common (66.7% vs. 34.2%, P= .04). BMI > 30 approached significance (58.3% vs. 29.3%, P= .06). Seven patients had subclinical lymphedema. No differences were identified comparing patients with subclinical lymphedema to those with negative scores. All 5 patients with clinical lymphedema underwent ALND and received nodal RT.ConclusionThe combination of ALND and regional nodal RT is strongly associated with development of clinical lymphedema. It is difficult to identify patients at risk for subclinical BIS-detected lymphedema. 相似文献
8.
背景与目的:上肢淋巴水肿是乳腺癌常见的治疗相关不良反应,显著影响乳腺癌患者的生存质量。本研究旨在观察乳腺癌改良根治术后放疗患者的上肢淋巴水肿发生情况,分析淋巴水肿发生与患者腋淋巴结手术结果(阳性淋巴结个数、切除淋巴结总数及两者的比值,即淋巴结阳性率)的相关性,以及年龄、体质量指数和其他治疗相关因素对上肢淋巴水肿发生的影响。方法:前瞻性收集2015年1月1日—12月31日在上海市黄浦区中心医院行乳腺癌改良根治术后放疗的患者共202例,采用上肢周径测量法,观察这些患者从放疗开始至放疗结束后12个月期间的上肢淋巴水肿发生情况。结果:共有197例患者完成随访观察,其中38例诊断为上肢淋巴水肿(19.3%)。单因素分析结果显示,发生与未发生上肢淋巴水肿的患者在切除淋巴结总数(P <0.001)、阳性淋巴结个数(P<0.001)与淋巴结阳性率(P=0.002)方面差异均有统计学意义,而在年龄、体质量指数和其他治疗相关因素方面差异无统计学意义。多因素分析结果显示,切除淋巴结总数的增多是乳腺癌改良根治术后放疗患者上肢淋巴水肿发生的独立危险因素(P<0.001)。结论:乳腺癌改良根治术后放疗患者的上肢淋巴水肿发生情况与腋淋巴结手术结果具有相关性,其中切除淋巴结总数的增多是淋巴水肿发生的独立危险因素。因此,对于切除淋巴结总数较多的患者,在制定术后相关治疗方案时要充分重视其较高的乳腺癌相关淋巴水肿发生风险。 相似文献
9.
目的:探讨微波治疗乳癌手术及术后放疗引起上肢淋巴水肿的临床疗效.方法:对56例乳癌手术及术后放射治疗引起的上肢淋巴水肿患者采用微波治疗.结果:总缓解率100%;完全缓解率64.3%(36/56);部分缓解率30.4%(17/56),轻度缓解率3.6%(3/56).轻/中度水肿缓解率100%(48/48);重度水肿缓解率62.5%(5/8).单纯手术后水肿缓解率100%(29/29);术后放疗后水肿缓解率88.9%(24/27).统计学分析,轻/中度淋巴水肿和重度淋巴水肿缓解率之间有显著性差异(P<0.01);单纯手术后淋巴水肿和术后加放疗淋巴水肿缓解率之间有显著性差异(P<0.01);术后放射治疗发生重度淋巴水肿患者无完全缓解病例.结论:微波治疗能使乳腺癌手术及术后放疗引起的上肢淋巴水肿减轻、消退,淋巴水肿程度愈轻疗效愈好,术后放疗且重度淋巴水肿患者疗效不佳. 相似文献
10.
BACKGROUND: Early detection and multimodality therapy has resulted in an overall improvement of survival among breast cancer patients. Despite a significant shift in the treatment approach from radical mastectomy to breast conservation a significant number of patients develop lymphedema. This study was conducted to evaluate the prevalence and risk factors for development of lymphedema. SETTINGS AND DESIGN: Retrospective analysis for prevalence of lymphedema in a tertiary care regional cancer centre. MATERIAL AND METHODS: Three hundred treated breast cancer patients with a minimum follow up of one year were evaluated for the prevalence and risk factors for lymphedema. Lymphedema was assessed using a serial circumferential measurement method. More than 3 cm difference in circumference is considered as clinical significant lymphedema. Univariate and multivariate analysis were performed for evaluating the risk factors by using the Chi square test and Cox logistic regression analysis. RESULTS: The prevalence of clinically significant lymphedema was 33.5 % and 17.2 % had severe lymphedema. The prevalence of lymphedema was 13.4 % in patients treated with surgery only where as the prevalence was 42.4% in patients treated with surgery and radiotherapy. Stage of the disease, body surface area > 1. 5 m2, presence of co-morbid conditions, post operative radiotherapy and anthracycline based chemotherapy were significant risk factors in univariate analysis where as axillary irradiation and presence of co-morbid conditions have emerged as independent risk factors in multivariate analysis (P < 0.001). CONCLUSION: Post treatment lymphedema continues to be a significant problem following breast cancer therapy. Presence of co-morbid conditions and axillary radiation significantly increases the risk of lymphedema. A combination of axillary dissection and axillary radiation should be avoided whenever feasible to avoid lymphedema. 相似文献
11.
BACKGROUND: Upper limb lymphedema occurs in approximately 15-20% of women after breast cancer treatment. We analysed the factors associated with lymphedema volume. METHOD: Cross-sectional study of 807 patients with secondary arm lymphedema was performed in a single lymphology unit. Data collected included patient characteristics, characteristics of breast cancer treatment, past history of cellulitis, Body Mass Index, delay from cancer to onset of lymphedema and duration of lymphedema. Lymphedema volume was calculated for each 5-cm segment by utilizing the formula for a truncated cone. Univariate and multivariate regression models were fitted to study the factors associated with increased lymphedema volume. RESULTS: In univariate analysis, factors associated with lymphedema volume were duration of lymphedema, Body Mass Index, mastectomy, and past history of cellulitis. Treatment with anti-estrogen drugs was negatively associated with lymphedema volume (p = 0.02). In multivariate analysis, factors associated with lymphedema volume were duration of lymphedema (p < 0.001), Body Mass Index (p < 0.001), delay from cancer to onset of lymphedema (p = 0.002), mastectomy (p = 0.02) and past history of cellulitis (p = 0.011). CONCLUSION: Early diagnosis and management of lymphedema, weight control and advices to avoid cellulitis are the main controllable parameters in women to prevent severity of breast cancer-related lymphedema. 相似文献
12.
Degnim AC Miller J Hoskin TL Boughey JC Loprinzi M Thomsen K Maloney S Baddour LM Cheville AL 《Breast cancer research and treatment》2012,134(3):915-922
Although lymphedema of the arm is a well-known complication of breast and axillary surgery, breast lymphedema has received scant attention. We sought to prospectively characterize breast lymphedema's incidence, associated symptoms, clinical course, and impact on quality of life. Subjects were enrolled prospectively from a consecutive sample of patients undergoing non-mastectomy breast procedures (excisional biopsy or wide local excision ± lymph node removal) and followed for signs and symptoms of lymphedema in the operated breast. Symptoms and distress were serially assessed with 11-point linear analog scales. Breast lymphedema was diagnosed independent of symptoms, based on the distribution and degree of edema and erythema. One hundred twenty-four women were followed for a median of 11 months, and breast lymphedema was diagnosed in 38 (31%) women. Breast lymphedema was more frequent after breast surgery with axillary node removal (49%) compared to breast surgery alone (0%), p < 0.0001. Breast lymphedema involved multiple quadrants in most women and was characterized by edema in 100% and erythema in 79%. Patients with breast lymphedema were significantly more likely than women without breast lymphedema to report symptoms of breast heaviness (65% vs 22%, p < 0.0001), redness (62% vs 29%, p = 0.0006), and swelling (59% vs 22%, p < 0.0001), but symptom-associated distress was low overall. Three of 32 breast lymphedema patients with clinical follow-up developed chronic edema. Breast lymphedema occurs in approximately one-half of women who undergo breast surgery with axillary node removal. The condition is characterized by diffuse skin edema and erythema as well as self-reported symptoms with a low level of distress. 相似文献
13.
Michael J. Bernas Robert L. Askew Jane M. Armer Janice N. Cormier 《Current breast cancer reports》2010,2(1):53-58
Lymphedema is an under-recognized, progressive, life-long condition estimated to impact 2-3 million people in the United States.
The incidence of breast cancer related lymphedema varies greatly in the literature largely due to different measurement techniques,
competing thresholds for defining lymphedema, and variation in length of follow-up. Multiple imaging techniques have become
useful for diagnosis. Lymphoscintigraphy is one of the most commonly used, as it can identify pathways of lymphatic drainage,
quantify extent of dermal backflow, and help determine functional and morphologic changes in the lymphatic system. Early detection
and intervention hold the greatest promise of reducing the incidence of lymphedema. Health care providers involved with cancer
patients need to become more educated about lymphedema, aware of current risk-reduction practices, and familiar with methods
of diagnosis and assessment, so that patients with early swelling can be referred to lymphedema treatment specialists at a
time when treatment is more effective. 相似文献
14.
《European journal of surgical oncology》2023,49(7):1177-1183
BackgroundWhether the breast reconstruction modality could influence the long-term development of post-mastectomy lymphedema has been little investigated. The present study aimed to evaluate the potential association of the breast reconstruction method with the incidence of lymphedema over an extended follow-up period.MethodsPatients with breast cancer who underwent immediate reconstruction from 2008 to 2014 were reviewed. They were categorized into three groups according to the reconstruction method: tissue expander/implant, abdominal flaps, and latissimus dorsi (LD) muscle flaps. Differences in the cumulative incidence of lymphedema by the reconstruction method were analyzed, as well as their independent influence on the outcome. Further analyses were conducted with propensity-score matching for baseline characteristics.ResultsIn total, 664 cases were analyzed with a median follow-up of 83 months (402 prostheses, 180 abdominal flaps, and 82 LD flaps). The rate of axillary lymph node dissection was significantly higher in the LD flap group than in the other two groups. The 5-year cumulative incidences of lymphedema in the LD flap, abdominal flap, and prosthesis groups were 3.7%, 10.6%, and 10.9%, respectively. In multivariable analyses, compared to the use of the LD flap, that of tissue expander/implant and that of abdominal flaps were associated with increased risks of lymphedema. A similar association was observed in the propensity-score matching analysis. The use of abdominal flaps or prostheses was not associated with the outcomes.ConclusionsOur results suggest that the method of immediate breast reconstruction might be associated with the development of postmastectomy lymphedema. 相似文献
15.
McNeely ML Magee DJ Lees AW Bagnall KM Haykowsky M Hanson J 《Breast cancer research and treatment》2004,86(2):95-106
PURPOSE: The purpose of this investigation was to compare the reduction in arm lymphedema volume achieved from manual lymph drainage massage (MLD) in combination with multi-layered compression bandaging (CB) to that achieved by CB alone. METHODS AND MATERIALS: Fifty women with lymphedema (mean age of 59 years +/- 13 years) were randomly assigned to 4 weeks of combined MLD/CB or CB alone. The primary study endpoint was the reduction in arm lymphedema volume, which was determined by water displacement volumetry and measurement of circumference. Independent assessors, blinded to subject treatment assignment, performed the outcome measurements. RESULTS: Arm lymphedema volume decreased significantly after 4 weeks irrespective of treatment assignment (p < 0.001). Individuals with mild lymphedema receiving combined MLD/CB had a significantly larger percentage reduction in volume compared to individuals with mild lymphedema receiving CB alone, and compared to individuals with moderate or severe lymphedema receiving either treatment. CONCLUSION: These findings indicate that CB, with or without MLD, is an effective intervention in reducing arm lymphedema volume. The findings suggest that CB on its own should be considered as a primary treatment option in reducing arm lymphedema volume. There may be an additional benefit from the application of MLD for women with mild lymphedema; however, this finding will need to be further examined in the research setting. 相似文献
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Lymphedema is an atypical accumulation of high-protein fluid located just beneath the skin, which often occurs in the arm or leg. Exercising with lymphedema was traditionally considered to be unsafe. However, recent research indicates that exercise may be beneficial to individuals with lymphedema. Studies indicate that exercise can improve the range of motion and strength of the afflicted limb(s), as well as overall fitness and functional quality of life, and can be performed without exacerbating symptoms of lymphedema. 相似文献
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Stewart-Treves syndrome is angiosarcoma, which occurs in the chronic lymphedema of the upper or lower limbs. Presently, an effective therapy is not established. The survival period is only several months to one year. There are some reports that angiosarcoma will occur in the period of 5~15 years after a continuation of lymphedema of the extremities. Therefore, it is important to prevent lymphedema after surgical operations of primary disease and the lymphedema. 相似文献
20.
Amanda Pigott Bena Brown Nicole White Steven McPhail Sandro Porceddu Howard Liu Claire Jeans Ben Panizza Jodie Nixon 《Asia-Pacific Journal of Clinical Oncology》2023,19(4):473-481