Postoperative swelling of the affected upper extremity in breast cancer patients
1.Incidence
Foreign 6～60％
Domestic 15～33%
2.Occurrence time
June to four years after surgery
3.Cause
Congenital hypoplasia of lymphatic vessels
Surgery → excision. Post-operative scar adhesion
Radiotherapy → local tissue fibrosis
4.Grading
Mild: the circumference of the affected side is less than 3CM thicker than that of the healthy side, or the proximal part of the upper limb, or the disease duration is short (within six months).
Moderate: the circumference of the affected side is 3CM-6CM thicker than the healthy side, or the whole upper limb.
Severe: the circumference of the affected side is thicker than the healthy side by more than 6CM, or the skin is hard and tough, or the swelling of the fingers, forearm, upper arm and shoulder joint is severely restricted, and the infection is easy to appear such as dermatitis and subcutaneous capillary lymphadenitis.
5.Prevention (70～80%)
(1) Factors that reduce the obstruction of blood and lymphatic fluid reflux
Appropriate activity in the early postoperative period
No infusion, blood sampling and blood pressure measurement of the affected upper limb
Prevention of infection in the affected upper limb (lymphangitis)
Clothing cuffs and bra straps should be loose
(2) Reduce the flow of blood and lymphatic fluid into the affected upper limb
Avoid lifting heavy objects on the affected upper limb
Reduce the droop of the affected upper limb (usually put the hand in the pocket of the blouse or skirt as much as possible)
Avoid overheating or overcooling of the arm
Pay attention to a low-salt diet
(3) Help blood and lymphatic fluid return
Elevate the arm above the heart
Compression bandage, compression garment
(4) Reduce friction on the skin during radiation therapy
It is appropriate to wear pure cotton clothes
Keep it clean and dry, do not put on irritating things such as adhesive tape
Adhere to exercise
6.Treatment
Drug treatment: diuretics, mai zhi ling, ai ve lang (diosmin), etc.
Physiotherapy: manual lymphatic drainage massage, oral negative pressure suction
Pressure pump treatment? (controversial)
Low-level radiation therapy, low-power laser therapy
Surgical treatment: lymphovascular-venous anastomosis plus pressure therapy