综合淋巴消肿疗法在乳腺癌术后上肢淋巴水肿患者中的应用

Application of complex decongestion therapy in patients with upper limb lymphedema after breast cancer surgery

目的 探讨综合消肿疗法（CDT）在乳腺癌术后上肢淋巴水肿患者中的应用疗效。方法 2015 年4 月—2016 年12 月根据便利抽样法选择52 例乳腺癌术后的淋巴水肿患者实施1 个疗程（20 次）的CDT治疗。采用肢体周径测量、多频生物电阻人体成分分析评估治疗前后水肿的消退程度，用Fugl-Meyer评分法和Bathel指数评估治疗前后运动和生活能力。结果 治疗前后患肢不同部位（虎口、腕横纹上5 cm、肘横纹下10 cm、肘横纹上10 cm、腋窝）周径对比差异有统计学意义（t值分别为20.014、 10.114、9.190、6.995、3.832；P＜ 0.01），肢体周径比率、组织水分比率对比差异有统计学意义（t值分别为 34.058、22.196；P＜ 0.01）。治疗后患者的肢体运动功能的Fugl-Meyer 评分和生活能力Bathel 指数高于治疗前，差异均有统计学意义（t 值分别为28.446、38.285；P ＜ 0.01）。结论 综合消肿疗法是治疗乳腺癌术后上肢淋巴水肿有效、安全的物理治疗手段，值得临床推广。

Objective To explore the application effects of complex decongestion therapy （CDT） in patients with upper limb lymphedema after breast cancer treatment. Methods From April 2015 to December 2016, a total of 52 cases of breast cancer patients with postoperative upper limb lymphedema were selected by convenience sampling method and treated with CDT for 1 course （20 times of CDT treatment）. Limb circumference measurements and multiple-frequency bioe｜ectrical impedance analysis were applied to evaluate the degeneration degree of edema. Fugl-Meyer and Bathel index were applied to assess the motor function and living ability before and after treatment. Results The differences of circumference of different parts of the affected limb （including thumb web, 5cm proximal to rasceta, 10 cm distal to cubital crease, 10 cm proximal to cubital crease and axilla） before and after intervention were statistically significant （t=20.014, 10.114, 9.190, 6.995, 3.832; P 〈 0.01）. The differences of circumferential ratio and tissue moisture ratio before and after intervention were statistically significant （t=34.058, 22.196; P 〈 0.01）. The score of Fugl-Meyer on patients＇ limb movement function and the Bathel index both, and the differences were statistically significant （t=28.446, 38.285; P 〈 0.01）. Conclusions CDT is an effective and safe treatment for upper limb lymphedema after breast cancer surgery, and worthy of clinical promotion.