乳癌術後之上肢問題的醫學新知與物理治療

New Concepts of Shoulder-Arm Problems after Breast Cancer Surgery: Its Impact on Physical Therapy

黃睦升(Mu-Sheng Huang) ； 蔡美文(Mei-Wun Tsai)

《物理治療》 32卷6期 (2007/12) Pp. 324-332

摘要

傳統以來，腋下淋巴結清除(axillary lymph node dissection)被用以檢視腋下淋巴結有否被乳癌病灶轉移，作為癌症分期及預後最重要的因子，在治療過程中可用來預測癌症的復發率及存活率。但是腋下淋巴結清除後常有一些不可避免的後遺症或併發症，不僅影響病患日常活動也使生活品質變差。常見的乳癌術後上肢問題，除了已熟知的患部肩關節易活動受限及淋巴水腫外，目前在術後早期亦發現有患側傷口血清腫、傷口感染、患部關節周遭疼痛、麻木等血清腫(seroma)、乳癌治療後疼痛症候群(post-breast therapy pain syndrome)、及腋網症候群(axillary web syndrome)的問題。本文回顧整理乳癌術後併發症的臨床特性及發生率，並利用失能進程模式探討其與乳癌術後上肢功能受限的關係，同時提醒臨床物理治療師能選擇合適的乳癌術後物理治療項目，並施予廣泛性的治療介入，減少乳癌患者術後的功能受限及社交障礙，進而提升其整體的生活品質滿意度。

關鍵字

乳癌治療後疼痛症候群 ； 淋巴水腫 ； 腋網症候群 ； 血清腫 ； 物理治療

並列摘要

Axillary lymph node dissection (ALND) has traditionally been the gold standard for staging the axilla in patients with breast cancer, and a predictor for recurrent and survival rate. Besides the well-known complications of shoulder dysfunction and lymphedema, other shoulder-arm problems following ALND such as post breast therapy pain syndrome, axillary web syndrome, and seroma have been successively documented. These shoulder-arm problems may interfere with the activities of daily life and quality of life of patients after breast cancer surgery. In this article, we reviewed the possible risk factors, patholophysiology, incidence, and clinical features for each shoulder-arm problem after breast cancer surgery, and identified the relationships among pathology, impairment, and functional limitations based on a disablement process model. The role of physical therapists, actively to prevent and treat the development of pain and loss of arm function, was also discussed.

並列關鍵字

Axillary lymph node dissection ； Post breast therapy pain syndrome ； Lymphedema ； Axillary web syndrome ； Seroma ； Quality of life ； Physical therapy