探讨徒手淋巴引流对乳腺癌术后淋巴水肿的临床效果。

回顾性分析2015年1月至2016年10月在中山大学孙逸仙纪念医院乳腺肿瘤中心接受乳腺癌改良根治术的80例女性患者的病历资料，年龄28～82岁，平均年龄(53.4±4.6)岁。按随机数字表法将患者分为观察组和对照组，每组40例。对照组患者进行常规护理；观察组患者在此基础上接受徒手淋巴引流和健康教育等护理干预。比较两组患者术后1周、1、3、6及12个月时的淋巴水肿发生率、腋网综合征(AWS)发生率和肩关节外展功能。

两组患者在术后1周时均未发生淋巴水肿，且术后1个月两组患者淋巴水肿发生率间的差异无统计学意义(P>0.05)；但观察组患者术后3、6和12个月的淋巴水肿发生率分别为2.5%(1/40)、5.0%(2/40)和7.5%(3/40)，低于同时间的对照组[7.5%(3/40)、12.5%(5/40)和20.0%(8/40)]，差异有统计学意义(P均<0.05)。术后3、6、12个月，观察组患者的AWS发生率分别为2.5%、5.0%、7.5%，对照组为12.5%、15.0%、20.0%，差异均具有统计学意义(P<0.05)。术后1周、1、3、6、12个月，关节外展度分别达到45°、90°、180°、180°、180°的观察组患者例数为24例、27例、30例、40例及40例，对照组分别为20例、21例、25例及34例，差异均具有统计学意义(P均<0.05)。

对乳腺癌改良根治术后患者进行徒手淋巴引流预防淋巴结水肿能够显著降低腋网综合征，利于关节功能的恢复，值得推广应用。

To investigate the clinical effect of manual lymphaticdrainage on postoperative lymphadenopathy after breast cancer.

A review was done on data of 80 female patients at age of 28-82 years [(53.4±4.6) years] treated with radical mastectomy for breast cancer from January 2015 to October 2016. According to the random number table method, 80 patients were randomly divided into observation group and control group, 40 cases in each group. The patients in the control group were treated with routine nursing. The observation group received nursing care such as free lymphatic drainage and health education., AWS incidence and shoulder abduction were measured at 1 week, 1 month, 3 months, 6 months and 12 months after operation.

There was no significant difference in the incidence of lymph edema between the two groups (P>0.05). However, the incidence of lymphadenopathy between the two groups was not statistically significant (P> 0.05). But the incidence of lymph edema at 3, 6 and 12 months was 2.5% (1/40), 5.0% (2/40) and 7.5% (3/40), respectively, which was lower than that of the control group (7.5%, 12.5% and 20.0%). The difference was statistically significant(P<0.05). The incidence of AWS in the observation group was 2.5%, 5.0% and 7.5%, as compared with 12.5%, 15.0% and 20.0% in the control group at 3, 6 and 12 months respectively, with statistically significant difference (P<0.05). At 1 week, 1 month, 3 months, 6 months, 12 months, the degree of external surgery up to 45 °, 90 °, 180 °, 180 ° and 180 ° respectively was seen in 24, 27, 30, 40 and 40 patients respectively in the observation group but in 20, 21, 25 and 34 patients respectively in the control group, with statistically significant difference (P<0.05).

The prevention of lymph node edema in patients with improved breast cancer after radical operation can significantly reduce the axillary network syndrome, which is beneficial to the recovery of joint function and is worthy of popularization and application.