综合消肿疗法治疗乳腺癌术后上肢淋巴水肿临床研究

Complex decongestion therapy in treating upper limb lymphedema after operation of breast cancer

目的探讨综合消肿疗法(CDT)治疗乳腺癌术后上肢淋巴水肿的临床疗效。方法选取沈阳军区总医院全军肿瘤诊治中心自2016年3月至2017年3月收治的44例乳腺癌术后上肢淋巴水肿患者,在双侧腕部上5 cm、肘部下10 cm、肘部上10 cm、虎口、腋窝处设5点进行周径测量。按照治疗前健、患肢周径差值(d)将上肢淋巴水肿分为3组,A组(轻度水肿)15例,d<3 cm;B组(中度水肿)16例,3 cm≤d≤5 cm;C组(重度水肿)13例,d>5 cm。3组患者均进行一个疗程(20 d)CDT治疗,比较CDT治疗前后患肢的周径值,并分析CDT疗效。结果 CDT治疗后,患者腕部上5 cm、肘部上10 cm、肘部下10 cm、虎口以及腋窝5个部位的周径比率下降量情况,A组与B组比较,差异均有统计学意义(P<0.05);A组与C组比较,差异均有统计学意义(P<0.05);B组与C组在肘部上10 cm、肘部下10 cm及腋窝3个部位的周径比率下降量比较,差异均有统计学意义(P<0.05),在腕部上5 cm和虎口2个部位的周径比率下降量比较,差异均无统计学意义(P>0.05)。结论 CDT适用于任何程度乳腺癌术后所致上肢淋巴水肿,且重度淋巴水肿疗效最显著。

Objective To investigate the curative effect of complex decongestion therapy（CDT） in treating upper limb lymphedema after radical resection of breast cancer. Methods A retrospective study was performed on 44 cases of breast cancer after treatment of upper limb lymphedema who were admitted from March 2016 to March 2017. On 5 cm above the two sides of the wrist,10 cm under the elbow,10 cm above elbow,the fingers between the thumb and forefinger and axillary totally 5 points for the measurement of the circumference. According to the treatment before the healthy,limb difference in the upper limb lymphatic edema was divided into 3 groups,Group A（mild edema） in 15 cases： the difference between the circumference of the contralateral and ipsilateral limb（d） was less than 2 cm; Group B（moderate edema） in 16 cases： d was more than 2 cm and less than 5 cm; Group C（severe edema） in 13 cases： d was more than 5 cm. Three groups of patients underwent a course of treatment（20 days） with CDT. The same technique used to the same specificational tape for measure and compare the peripheral diameter of the limbs before and after treatment with CDT to analyze the efficacy of CDT. Results After CDT treatment,the ratio change of percentage of limb circumference reduction at five parts of the limb,including the 5 cm above the wrist,10 cm above the elbow,10 cm under the elbow,at the fingers between the thumb and forefinger,and axillary,the results had statistically significant difference between Group A and Group B（P〈0. 05）; the difference between Group A and Group C had statistically significance（P〈0. 05）; the ratio change of limb circumference reduction at three parts of the limb,including 10 cm above the elbow,10 cm below the elbow and axillary,the results had statistically significant difference between group B and C（P〈0. 05）; the ratio change of limb circumference reduction at two parts of the limb,including the 5 cm above the wrist,the fingers between the thumb and forefinger,the result had no statistically significant difference between Group B and Group C（P〈0. 05）. Conclusion CDT is suitable for any degree of breast cancer caused by postoperative limb lymphedema,and the most significant effect of severe lymphedema.