Study Of Mechanism And Therapy Of Postmastectomy Upper Extremity Edema In Breast Cancer

AIM: To investigate the mechanism of postmastectomy upper extremity edema in breast cancer concerning the obstruction of lymphatic return and stricture of axillary vein; to evaluate the effect of extremity circulation driving therapeutic device on upper extremity edema , investigate its mechanism and assess it by radionuclide scanning of both upper extremities, so as to guide the comprehensive treatment of postmastectomy upper extremity edema in breast cancer.METHODS: We examined bilateral axillary veins of 48 breast cancer patients with postmastectomy upper extremity edema bycolor Doppler ultrasound technique to measure the axillary veins diameter and blood flow. Based on the degree of upper extremity edema, we divided patients into light, moderate or severe group, and performed different strategies with various pressure and time using extremity circulation "driving therapeutic device. Among the 48 patients, 15 patients who had been chosen randomly before treatment underwent radionuclide scanning of both upper extremities to examine the changes of lymph flow before and after treatment respectively.RESULTS: 9 of 48 patients (18.75%) had stricture of axillary vein in extremity involved(the vessels' diameter on this side decreased more than 50% when compared with the sound side), and blood flow rate also decreased. These patients consists of 1 light case , 6 moderate cases, 2 severe cases. The patients with strictured axillary vein had more severe edema than those with normal axillary vein (P<0.05). In patients with light to moderate edema, the circumference of extremity involved decreased significantly after treatment (P<0.01), and extremity edema also relieved. Radionuclide scanning of both upper extremities demonstrated that the lymph flow of extremity involved increased remarkably aftertreatment compared with that before treatment. Total response rate was 87.5% in all patients. However, the treatment was effective only in 1 of 4 patients with severe edema.CONCLUSION: The postmastectomy upper extremity edema in breast cancer was mainly due to lymphatic return damage in upper extremity caused by axillary lymph node sweeping. In addition, the stricture of axillary vein caused by surgery and post-surgery scars in axilla could contribute to the occurrence and development of upper extremity edema. The obvious effect of extremity circulation driving therapeutic device on light to moderate edema makes it an economical, convenient and effective approach for clinical application. This kind of treatment not only improves the lymphatic return in extremity involved, but also increases the venous return. But the effect of extremity circulation driving therapeutic device on severe edema is still unsatisfactory, so it is needed to search after other treatments.