Barriers to rehabilitation following surgery for primary breast cancer
Barriers to rehabilitation following surgery for primary breast cancer
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DOI：
10.1002/jso.20782
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发表时间：
2007-04-01
影响因子：
2.5
通讯作者：
Tchou, Julia
中科院分区：
文献类型：
--
作者：
Cheville, Andrea L.;Tchou, Julia
手术是原发性乳腺癌治疗的支柱。手术技术的改变减少了正常组织损伤，但治疗后疼痛和功能损害继续发生。大量专家意见支持的脆弱证据表明，采用传统康复方式进行早期干预可以减少手术相关的疼痛和功能障碍。本文详细讨论了功能性病态后遗症及时康复的障碍。障碍来自广泛的学术、人力、后勤和财务来源。尽管存在障碍，许多机构仍定期为乳腺癌患者提供快速有效的术后康复服务。这一经验引发了有关处理可能损害功能的常见后遗症的轶事信息。本文概述了这些后遗症的流行病学、病理生理学和治疗，并强调了支持证据的质量。解决了肌筋膜功能障碍、腋窝网综合征、肩周炎、淋巴淤滞、乳房切除术后综合征以及乳房重建后供区发病率的问题。当前手术后遗症治疗算法的特点是迫切需要更明确的证据来指导患者管理。 J.外科医生。安科尔。 2007；95：409-418。 (C) 2007 Wiley-Liss, Inc.
Surgery is a mainstay of primary breast cancer therapy. Alterations in surgical technique have reduced normal tissue injury, yet pain and functional compromise continue to occur following treatment. A tenuous evidence base bolstered by considerable expert opinion suggests that early intervention with conventional rehabilitative modalities can reduce surgery- as soc i ated pain and dysfunction. Barriers to the timely rehabilitation of functionally morbid sequelae are discussed at length in this article. Barriers arise from a wide range of academic, human, logistic, and financial sources. Despite obstacles, expeditious and effective post-surgical rehabilitation is being regularly delivered to breast cancer patients at many institutions. This experience has given rise to anecdotal information on the management of common sequelae that may undermine function. The epidemiology, pathophysiology, and management of these sequelae are outlined in this article with an emphasis on the caliber of supporting evidence. Myofascial dysfunction, axillary web syndrome, frozen shoulder, lymphostasis, post-mastectomy syndrome, and donor site morbidity following breast reconstruction are addressed. A critical need for more definitive evidence to guide patient management characterizes the current treatment algorithms for surgical sequelae. J. Surg. Oncol. 2007;95:409-418. (C) 2007 Wiley-Liss, Inc.