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乳腺癌再放疗后放射性臂丛神经病变1例报告

Radiation-induced brachial plexopathy after radiotherapy for breast cancer: a case report

  • 摘要: 放射性臂丛神经病变(radiation-induced brachial plexopathy, RIBP)是乳腺癌放疗后严重且不可逆的并发症,治疗手段有限,预防和长期管理是降低RIBP致残率、改善患者生活质量的关键。本文回顾性分析1例就诊于上海市静安区中心医院康复医学科的女性乳腺癌患者在根治术后11年接受2次放射治疗后出现RIBP相关症状的诊疗经过。患者经臂丛神经松解术后疗效有限,入院后给予关节牵伸、残存肌力维持训练、作业治疗、加巴喷丁镇痛、脱敏训练及患肢保护等综合康复护理。出院时,疼痛评分量表由5分降至2~3分,肩肘被动活动度及日常生活活动能力改善,但抓握力和感觉障碍未见明显恢复。本文结合该病例和文献,探讨乳腺癌再放疗后RIBP的早期识别、鉴别诊断和全程康复管理,以期为临床实践提供参考。

     

    Abstract: Radiation-induced brachial plexopathy (RIBP) is a severe and irreversible complication following radiotherapy for breast cancer. As treatment options are limited, prevention and long-term management are key to reducing the disability rate associated with RIBP and improving patients’quality of life. This article presents a retrospective analysis of the clinical course of a female breast cancer patient who presented to the Department of Rehabilitation Medicine at Shanghai Jing’an District Central Hospital with RIBP-related symptoms 11 years after radical mastectomy and two courses of radiotherapy. The patient had experienced limited benefit from brachial plexus neurolysis; following admission, she received comprehensive rehabilitation care comprising joint stretching, exercises to maintain residual muscle strength, occupational therapy, gabapentin for pain relief, desensitisation training and protection of the affected limb. Upon discharge, her pain had decreased from an numerical rating scale of 5 to 2–3, and there was improvement in passive range of motion at the shoulder and elbow joints as well as in activities of daily living; however, no significant recovery was observed in grip strength or sensory deficits. Based on this case and the literature, this article discusses the early identification, differential diagnosis and comprehensive rehabilitation management of RIBP following re-radiotherapy for breast cancer, with the aim of providing reference for clinical practice.

     

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