乳腺癌术后淋巴水肿防治相关系统评价的再评价

Overview of review on the prevention and treatment of breast cancer-related lymphedema

目的乳腺癌术后淋巴水肿(breast cancer-related lymphedema,BCRL)是乳腺癌患者术后常见、难以治愈的严重并发症,因此预防及治疗BCRL十分重要。本研究对防治BCRL相关系统评价进行再评价,为临床防治BCRL提供参考依据。方法计算机检索PubMed、EMbase、MEDLINE、The Cochrane Library、Web of Science、CNKI、CBM、WanFang Data和VIP数据库,检索防治BCRL相关系统评价或Meta分析,检索时限均从建库至2018-04。2位研究者独立检索、筛选文献和提取资料,并采用AMSTAR工具评价纳入研究的方法学质量。结果共纳入20个系统评价,治疗11篇、预防3篇、预防及治疗6篇,内容涉及运动锻炼、徒手淋巴结引流(manual lymphatic drainage,MLD)、空气波压力泵(intermittent pneumatic compression,IPC)、中药、康复护理、运动机能贴扎(kinesiology taping,KT)、手术方式和自制软枕等方面。其中,运动锻炼、康复护理、KT、手术方式、中药和自制软枕防治BCRL有效(均P<0.05),MLD、IPC防治BCRL效果尚存在争议。AMSTAR评价结果显示,纳入研究的方法学质量问题主要表现为提供纳入排除的文献清单不清楚(85%)、未将发表情况考虑在纳入排除标准中(85%)、未评估发表偏倚(55%)和未说明利益冲突方面(50%)。AMSTAR评分在4～9分。结论运动锻炼、康复护理、KT、手术方式、中药和自制软枕对防治BCRL效果明显,但MLD和IPC防治BCRL效果尚未明确。受纳入研究质量和数量的限制,需开展更多高质量研究验证上述结果,为相关防治研究提供可靠证据。

OBJECTIVE Breast cancer-related lymphedema(BCRL)is a serious and common compliaction after surgery,which can't be cured.This study aimed to overview the systematic reviews on the prevention and treatment of BCRL,and offer evidence to prevent and treat BCRL for clinical practice.METHODS We searched databases including PubMed,EMbase,MEDLINE,The Cochrane Library,Web of Science,CNKI,CBM,WANFANG DATA,VIP from inception to April,2018 for systematic reviews/meta-anlyses about prevention and treatment of BCRL.Two researchers independently screened literature,extracted information and used AMSTAR to evaluate the quality of included studies.RESULTS A total of 20 studies were included,including about exercise,rehabilitation nursing,manual lymphatic drainage(MLD),intermittent penumatic compression(IPC),Chinese herbology,kinesiology taping(KT),different ways to surgery,manual soft pillow.The result of 11 items of AMSTAR showed,the item"the list of included or excluded literature(85%)",considering the publication into the inclusion and exclusion criteria(85%),"evaluating bias of publication(55%)","explaining the conflict of interest(50%)"were the most problematic item.AMSTAR scores were 4-9 points.COCLUSIONS Exercise,rehabilitation nursing,chinese herbology,KT,different ways to surgery,manual soft pillow could prevent or treat BCRL,but the effect of MLD and IPC was unclear.This study was limited by quantity and quality,so more high quantity studies are needed to verify the result and provide the reliable evidence to prevent and treat BCRL.