AIN AFTER BREAST CANCER SURGERY：乳腺癌手术后疼痛

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1、TREATINGPAINAFTERSURGERYAndreaV.Barrio,MD,FACSAttendingBreastSurgeonAssociateProgramDirector,BreastFellowshipProgramTheBrynMawrHospitalINTRODUCTIONBreastcancermostcommoncanceramongwomenACSestimates232,340newcasesin2013¹Secondmostcommoncausedeath39,620deathsin20

2、13¹Trendsin5Yr.survivalBREAST1975-19771984-19861996-2004CANCER75%79%89%¹www.cancer.orgPainaftersurgerySCOPEOFTHEPROBLEMEstimated2.9millionbreastcancersurvivors2012Persistentpostsurgicalpaindemonstratedin25-50%ofpatientsundergoingbreastcancersurgery¹Painaftersur

3、gery:Introduction¹KehletH,Lancet,2006OVERVIEWAnatomyPresentationofbreastcancerCommonsurgicalproceduresforbreastcancerCausesofacutepost-surgicalpainCausesofpost-surgicalsensorydisturbancesLymphedemaTreatmentPainaftersurgeryBREASTANDAXILLARYANATOMYBREASTANATOMYFe

4、malebreastLobules(milk-producingglands)Ducts(tubescarrymilkfromlobulestonipple)Stroma(fattytissueandconnectivetissuesurroundingductsandlobules)PainaftersurgeryTHELYMPHATICSYSTEMPartofbody’sdefensesystemMostlymphaticvesselsinthebreastconnecttolymphnodesunderthea

5、rm(axillarynodes)Someconnecttolymphnodesinsidethechest(internalmammarynodes)andsometothoseabovethecollarbone(supraclavicularnodes)PainaftersurgeryPainaftersurgery:AnatomyPainaftersurgery:AnatomyHOWDOBREASTCANCERSPRESENT?BREASTCANCERPRESENTATIONImagingabnormalit

6、yMassCalcificationsArchitecturaldistortionPalpablelumpSkinchangesChangesinnippleRashNippledischargePainaftersurgeryBREASTCANCERPRESENTATIONImagingabnormalityMassCalcificationsArchitecturaldistortionPalpablelumpSkinchangesChangesinnippleRashNippledischargePainaf

7、tersurgeryBREASTCANCERPRESENTATIONImagingabnormalityMassCalcificationsArchitecturaldistortionPalpablelumpSkinchangesChangesinnippleRashNippledischargePainaftersurgeryDiagnosisusuallymadewithimage-guidedbiopsyIMAGE-GUIDEDBREASTBIOPSYMinimallyinvasivebiopsystanda

8、rdofcareforinitialdiagnosisofimagingabnormalitiesHematomaafterbiopsycanoftencausesignificantdiscomfort/painPainaftersurgeryCANIDECREASEMYCHANCESOFHAVINGAPOST-BIOPSYHEMATOMA?