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乳房切除术后疼痛综合征：风险降低和治疗

Author
Jeannie Shen, MD
Section Editor
Anees B Chagpar, MD, MSc, MA, MPH, MBA, FACS, FRCS(C)
Deputy Editor
Wenliang Chen, MD, PhD
Translators
王鹏, 副主任医师

引言

乳房切除术后疼痛综合征(postmastectomy pain syndrome, PMPS)是一种慢性神经病理性疼痛疾病，发生在乳腺癌相关手术操作后[1-5]。降低PMPS风险和治疗PMPS的最佳方法见此专题。PMPS的临床表现和诊断见其他专题。 (参见“乳房切除术后疼痛综合征的临床表现和诊断”)

风险降低

由于缺乏对PMPS的明确定义，故在确定预防措施降低PMPS发病率的效果时需要特别注意。例如，一些研究将PMPS定义为持续3个月以上的疼痛，而其他研究则将其定义为持续18个月以上的疼痛。 (参见“乳房切除术后疼痛综合征的临床表现和诊断”，关于‘定义’一节)

超前镇痛 — 超前镇痛是指在伤害性刺激(如手术切口)发生前，给予局部或区域性镇痛药(如，伤口浸润、椎旁阻滞[6]、麻醉乳膏[7])，或给予全身性镇痛药(如，布洛芬、酮咯酸、加巴喷丁)。超前镇痛作为术后疼痛治疗的一部分的相关内容参见其他专题，包括对局部麻醉剂和全身性麻醉剂的概述。 (参见“Management of acute perioperative pain”, section on ‘Preventive analgesia’)

大多数前瞻性研究发现，对接受乳腺癌手术的患者给予超前镇痛具有围手术期益处，例如术后镇痛需求减少[8-12]。然而，超前镇痛对于长期疼痛控制和PMPS风险降低的作用尚未确定。由于不同的研究在研究设计，包括超前镇痛的应用和持续时间，以及观察持续时间等方面存在差异，故限制了直接比较。

下列研究发现了多种超前镇痛药(即局部、区域和全身)对于乳腺癌手术女性的短期疼痛控制益处：

        

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Literature review current through: 2017-06 . | This topic last updated: 2017-05-23.
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