复合理疗在妇科恶性肿瘤术后下肢淋巴水肿中的应用及效果评价

Application and effect evaluation of complex decongestive physiotherapy in lower extremity lymphedema after surgery for gynecological cancer

目的 评价复合理疗在妇科恶性肿瘤术后继发下肢淋巴水肿患者中的应用效果.方法 由肿瘤专科护士对2016年3月至2017年2月康复门诊的40例妇科恶性肿瘤术后下肢淋巴水肿患者进行复合理疗.在干预前后采用周径测量和多频生物电阻抗分析法进行效果评价.结果 复合理疗后,患肢水肿体积由（8668.30±1909.23）cm3降至（7599.81±1297.45）cm3,过剩体积比率由14.10（5.82~66.86）%降至2.95（0.38~28.56）%,差异有统计学意义（t=6.909、Z=-5.511,P〈0.05）.患肢组织水分由干预前（6.11±1.63）L降至干预后（5.06±0.88）L,患肢细胞外水分比率由（41.15±1.86）%降至（39.51±0.88）%,差异有统计学意义（t=6.336、8.295,P〈0.05）.体积减少比率高达（77.33±14.55）%,Spearman相关性分析显示体积减少比率与病程呈负相关（r=-0.359,P〈0.05）.结论 复合理疗治疗妇科恶性肿瘤术后下肢淋巴水肿疗效显著,并且早期康复效果优于晚期,是一套值得临床推广应用的安全无创疗法.

Objective To explore the effects of complex decongestive therapy among patients with postoperative lower extremity lymphedema following treatment for gynecological cancer. Methods A total of 40 patients with secondary lower extremity lymphedema resulting from gynecological cancer treatment received complex decongestive physiotherapy （CDP） by oncology nursing specialist in the lymphedema rehabilitation clinic between March 2016 to February 2017.Before and after CDP,patients were evaluated by circumferential measurements and multiple frequency bioelectrical impedance analysis. Results After CDP, lymphedema volume decreased from （8 668.30 ± 1 909.23） cm3to （7 599.81 ± 1 297.45）cm3, and the percentage of excess volume （PEV） reduced from 14.10 （5.82-66.86）% to 2.95（0.38-28.56）%, the differences were statistically significant（t=6.909,Z=-5.511,P〈0.05）.The accumulated edema fluid in tissue decreased from（6.11±1.63）L to （5.06 ± 0.88） L and the rate of extracellular water decreased from （41.15 ± 1.86）% to （39.51 ± 0.88）%, the differences were statistically significant （t=6.336, 8.295, P 〈 0.05）. Percentage reduction of excess volume （PREV）was（77.33±14.55）%,and was correlated with duration of lower extremity lymphedema. Conclusions CDP was effective for lower extremity lymphedema secondary to treatment of gynecological cancer.It is a set of safe and noninvasive technique. Patients with lower extremity lymphedema should be encouraged to undergo CDP, even when it is mild.