The Mechanism Of Postmastectomy Upper Extremity Edema And The Effect Of Lymphatic Vessels Anastomosis Treat It In Breast Cancer Survivors

Objectives Breast cancer is one of the most common malignant tumor of women all of the world. In China, aecording to the lates tassessment of IARC, the new case of female breast cancer amounts to 126,000 each year, which weights 14% of all female malignant tumors each year in China and about 26,600 female die from breast cancer. Although the comprehensive therapy of breast cancer got rapid development in recent years, but surgery is still the main treatment method, postmastectomy upper extremity edema following axillary lymph node dissection for breast cancer is a common complication. Our study around axillary upper limb edema after breast cancer and the mechanism of the lymphatic anastomosis to evaluate the treatment effect, for the clinical prevention of upper limb edema happened and provide theoretical basis for treatment.Methods Select 40 patients with upper limb edema after breast cancer operation between 2011-06 and 2013-06 in our hospital which all have microscopic lymphatic venous anastomosis. All have 4 to 24 months of follow-up study. Through measuring patients before and after operation on one side and the contralateral elbow horizontal stripes on week 10 cm in diameter values and calculated both differential worth edema, to improve the situation. Use bioelectrical impedence analysis analysis of upper limbs edema and calculate the ratio of ECW/ICW and ECW/TBW in upper limb.Results Breast cancer patients often with upper limb lymphedema, the main mechanism of it is the damaged part of the lymphatic circumfluence channel breast cancer surgery, lead to the upper extremity lymph circumfluence obstacle. 36 cases with lymphatic anastomosis after 4 weeks of microscopic lymphatic venous anastomosis, upper diameter reduced significantly, the total effective rate was 90%. Only 2 cases had postoperative infection. Statistical analysis show patients limb diameter were narrowed and the circumference of affected upper arm was significantly decreased from preoperative to postoperative(P<0.05). Compared with preoperative, the ratio of ECW/ICW and ECW/TBW in upper limb all reduced(P<0.05). 38 cases of patients with the longest follow-up 24 months, there are 2 cases appear edema, and the rest did not see a relapse.Conclusions Breast cancer surgery damaged the upper extremity lymph circumfluence pathway, lead to upper extremity lymph circumfluence obstacle and results to the upper extremity lymphedema. Microscopic lymphatic venous anastomosis can restore damaged lymphatic vessels, exact effect on treatment of postmastectomy upper limb lymphedema.