临床物理治疗方案对乳腺癌切除术后淋巴结病和关节活动受限的长期疗效评价:一个新的方案案例研究

Ketan Bhatikar
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引用次数: 1

摘要

乳房切除术是乳腺癌的一种治疗方法,而不是乳房保留手术。乳房切除术后有许多已知的副作用。其中包括疼痛压痛、手术部位肿胀、淋巴结病变、伤口积血(血肿)、伤口积液(血肿)、手臂或肩部活动受限、胸部或上臂麻木、神经性疼痛[1]。乳房切除术还对半数患者产生心理影响,包括对癌症的恐惧、身体不完整感、工作和社交不便、性行为减少和情绪低落[2]。乳腺癌治疗女性的淋巴水肿是由于腋窝淋巴结清扫或腋窝放射或两者兼有而导致腋窝淋巴引流中断时,腋窝富含蛋白质的液体在上臂积聚而发生的[3]。淋巴水肿仍然是一个非常值得关注的问题,因为没有任何现代治疗方法在减少淋巴水肿方面显示出显著的效果。这导致肩关节功能障碍和关节活动范围受限。研究中描述了淋巴水肿的三个阶段:第一阶段表现为凹陷,被认为是可逆的;有些女性在这个阶段没有臂围增加或沉重,也没有凹陷性水肿的迹象。随着水肿的进展,在II期,它变得粗壮、纤维化、无麻点和不可逆。晚期淋巴水肿,即乳腺癌治疗后很少发生的III期,出现软骨硬化,伴有乳头状瘤样生长和皮肤角化过度[4-6]。慢性淋巴水肿引起慢性炎症状态和随之而来的纤维化,使关节范围更难以疼痛治疗[7]。这进一步导致疼痛、毁容和残疾等症状。
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Evaluation of Long-Term Effect of Clinical Physiotherapy Treatment Protocol for Post Cancer Mastectomy Induced Lymphadenopathy and Restricted Joint Range: A Novel Protocol Case Study
Mastectomy is a treatment for breast cancer over breast-conserving surgeries. There are many side effects known post-mastectomy. Some of which are pain tenderness, swelling at the surgery site, lymphadenopathy, buildup of blood in the wound (hematoma), the buildup of clear fluid in the wound (seroma), limited arm or shoulder movement, numbness in the chest or upper arm, neuropathic pain [1]. Mastectomy also caused the psychological impact on half of the patients, which included fear of cancer, feeling of body incompleteness, inconvenience in working and social communication, less sexual act and low spirit [2]. Lymphedema in women treated for breast cancer is an accumulation of protein-rich fluid in the arm that occurs when axillary lymphatic drainage from the arm is interrupted because of axillary lymph node dissection or axillary radiation or both [3]. Lymphedema is still of great concern as no modern modalities have shown significant results in reducing lymphedema. This leads to dysfunction in the shoulder joint and restriction in joint range. Three stages of lymphedema have been described in studies that are: Stage I presents with pitting and is considered reversible; some women with this stage have no increased arm girth or heaviness and no signs of pitting edema. As the edema progresses, it becomes brawny, fibrotic, nonpitting and irreversible in stage II. In advanced lymphedema i.e. in stage III, which rarely occurs following breast cancer treatments, cartilaginous hardening occurs, with papillomatous outgrowths and hyperkeratosis of the skin [4-6]. Chronic lymphedema gives rise to a chronic inflammatory state and consequent fibrosis that make the joint range more difficult to treat with pain [7]. This further leads to symptoms such as pain, disfigurement, and disability.
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