综合消肿疗法改善妇科恶性肿瘤术后下肢淋巴水肿的效果观察

The therapeutic effect of complex decongestive physiotherapy for lower limb lymphedema after gynecological malignant tumor operation

目的分析综合消肿疗法(complex decongestive physiotherapy,CDP)对妇科恶性肿瘤术后下肢淋巴水肿(lower limb lymphedema,LLL)患者的治疗效果。方法选取2018年3月~2019年11月华中科技大学同济医学院附属同济医院收治的符合下肢淋巴水肿诊断标准的妇科恶性肿瘤术后患者89例。采用CDP对患者进行规范化治疗,通过分别测量治疗前后的下肢周径及下肢体积(lower limb volume,LLV)评估下肢水肿恢复情况,并通过多频生物电阻人体成分分析仪评价治疗效果。采用欧洲癌症研究与治疗组织生存质量问卷(EORTC-Q30)评估患者治疗前后生活质量,采用简易疲劳量表(BFI)评估患者疲劳的严重程度以及中文版贝克抑郁量表第2版(beck depression inventory-Ⅱ,BDI-Ⅱ)评估患者的抑郁情绪状态,同时采用30 s椅子站立试验及下肢肌力评价患者治疗前后下肢运动功能。结果治疗后,入组患者膝上25和15 cm、膝下10 cm、外踝上5 cm、足背中点的周径及LLV较治疗前有明显的改善,差异有统计学意义(P<0.05);此外,患者组织水分比率及周径率在治疗前后差异有统计学意义(P<0.05)。治疗后,患者的生活质量、下肢运动功能及情绪状态有明显的好转,差异有统计学意义(P<0.05)。结论CDP可有效改善妇科恶性肿瘤术后继发的下肢淋巴水肿,能显著降低患者的下肢周径并降低组织含水量,可有效提升患者的生存质量。

Objective To analyze the therapeutic effect of complex decongestive physiotherapy(CDP)on patients with lower limb lymphedema(LLL)after gynecological malignant tumor operation.Methods From March 2018 to November 2019,a total of 89 patients with postoperative gynecological malignant tumor who met the diagnostic criteria of LLL were selected as the observation subjects.CDP was used to standardize the treatment of the patients.The lower limb circumference and lower limb volume(LLV)before and after treatment were measured to evaluate the recovery of lower limb edema,and the treatment effect was evaluated by a multi-frequency bioelectrical resistance body composition analyzer.The European cancer research and treatment organization quality of life questionnaire(EORTC-Q30)was used to assess patients'quality of life before and after treatment,and brief fatigue inventory(BFI)was used to assess the severity of patient fatigue and the Chinese version of the Beck Depression Scale 2nd edition(Beck Depression Inventory-Ⅱ,BDI-Ⅱ)assesses the patient's depressive emotional state.At the same time,30 s chair standing test and lower limb muscle strength were used to evaluate the lower limb motor function.Results Before and after treatment,the circumference of 25 cm above the knee,15 cm above the knee,10 cm below the knee,5 cm above the lateral malleolus,the middle point of the dorsum of the foot and LLV were significantly improved(P<0.05);In addition,the patient's tissue water ratio and circumference ratio were statistically different before and after treatment(P<0.05);After the intervention,patients'quality of life,lower limb motor function,and emotional state improved significantly(P<0.05).Conclusion CDP can effectively improve in LLL secondary to gynecological malignancies,significantly reduce the patient's lower limb circumference and reduce the tissue water content,and can effectively improve the quality of life of patients.