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題 名 | Timing of Shoulder Exercise after Modified Radical Mastectomy: A Prospective Study=改良式乳房根除術後肩部運動何時開始最適當:一前瞻性之研究 |
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作 者 | 陳訓徹; 陳敏夫; | 書刊名 | 長庚醫學 |
卷 期 | 22:1 1999.03[民88.03] |
頁 次 | 頁37-43 |
分類號 | 416.226 |
關鍵詞 | 乳癌; 改良式乳房根除術; 腋下引流管量; Breast cancer; Mastectomy; Axillary drains; |
語 文 | 英文(English) |
中文摘要 | 背景:乳癌病人接受改良式乳房根除手術後腋下引流管越早拔除,可減少感染機 會,讓病人儘早接受輔助性治療。而腋下引流量的多寡和上臂運動有直接關係,若延緩上臂 的運動,引流量少,可較早拔除引流管。 方法:將病人前瞻性分成3組,早期拔除病人在手術後第3天即開始上臂運動包括鐘擺、爬牆 、拉繩及梳頭等運動,計有 116 人。較晚期拔除者計有 115 人,于第六天開始運動。延後 拔除病人計有 113 人,於所有引流管拔除後才開始運動。 結果:三組中,病人的年齡、體重、手術方法、病理結果、淋巴腺轉移與否等因素都沒有差 異。實驗結果顯示在延後拔除者其腋下引流量最少且明顯低於早期及較晚期拔除者,其引流 量分別為 485、567、558 毫升,p = 0.032。 而胸壁引流管的引流量則沒有差異,病人在 門診因腋下積血水而接受抽吸的次數也沒有差異。引流管拔除的時間在延後拔除者平均為七 天,而早期及較晚期為九天。引流管拔除後,對上臂運動機能恢復的追�j發現,雖然在延後 拔除的病人其運動在第 1 個月時受到限制,但在第 3 個月時可回到正常, 在第 6 個月所 做的觀察,3 組皆沒有差異。 結論:我們認為上臂的復健運動,可以延後到引流管皆拔除後才開始進行,可減少引流量, 提早拔除引流管,而不致於影響上臂運動機能的恢復。 |
英文摘要 | Background: There are several factors those contribute to the amount of axillary drainage after modified radical mastectomy. The drains should be removed as early as possible. Whether the active shoulder movement of the lesion side increases the amount of axillary drainage needs to be studied prospectively. Methods: From 1994 through 1995, 344 consecutive patients were randomly divided into three groups. One hundred sixteen patients in the early group performed upper arm exercises including pendulum, wall climbing and pulley exercises beginning the third post-operative day. One hundred fifteen patients in the later group patients did the same exercises beginning the sixth post-operative day and 113 patients in the delayed group did the same exercises after all the drains were removed. Results: There were no significant differences in patient characteristics, including age, body weight, operation methods and the pathology in the three groups. The amount of axilla fossa drainage was significantly less in the patients in the delayed group than in the early and later group (485 ml, 568 ml, 559 ml, respectively, p=0.032). However, there were no differences in the amount of chest wall site drainage or the number of aspiration of seroma among the three groups. The drains were removed on the average of seventh and ninth post-operative day in the delayed and early group patients, respectively (p=0.124). Although the range of motion (ROM) of the shoulders in the delayed group patients was slightly limited during the first month after operation, ROM returned at 3 months and no difference was found 6 months after operation. Conclusion: Upper arm exercise can start after the drains in the axilla are removed. The delay does not limit the shoulder function at 6 months after modified rodical mastectomy. |
本系統中英文摘要資訊取自各篇刊載內容。