改良综合消肿疗法对妇科盆腔肿瘤术后中重度下肢淋巴水肿的疗效分析

Analysis of the curative effect of modified complex decongestion therapy on moderate to severe lower limb lymphedema after gynecological pelvic tumor surgery

目的研究改良综合消肿疗法(complex decongestion therapy,CDT)对妇科盆腔肿瘤术后中重度下肢淋巴水肿(lower limb lymphedema,LLL)的疗效。方法随机将妇科盆腔肿瘤术后中重度LLL患者78例分为对照组(39例)和改良组(39例)。对照组患者用传统CDT治疗,包括手法淋巴引流(manual lymphatic drainage,MLD)、多层低弹力绷带包扎、功能锻炼以及自我皮肤护理;改良组用负压淋巴回流促进系统替代MLD,其余不变。治疗前及治疗4周后以卷尺测定患肢周径,计算肢体体积(lower limb volume,LLV),淋巴水肿相关症状量表评价淋巴水肿症状,多频生物电阻抗人体成分分析仪测定细胞外水分比率,超声显像检测皮肤全层增厚度、皮下组织增厚度、深筋膜增厚度、皮下组织回声评分、皮下组织形态评分,对患者情绪进行综合医院焦虑抑郁量表(Hospital Anxiety and Depression Scale,HADS)评分。结果与治疗前比较,治疗4周后对照组、改良组患者患肢周径、LLV、细胞外水分比率降低,淋巴水肿症状改善,皮肤全层增厚度、皮下组织增厚度、深筋膜增厚度、皮下组织回声评分、皮下组织形态评分降低,焦虑评分、抑郁评分降低,差异有统计学意义(P<0.05)。与对照组治疗后比较,改良组患者治疗后患肢周径、LLV、细胞外水分比率降低,淋巴水肿症状改善,深筋膜增厚度、皮下组织回声评分降低,焦虑评分、抑郁评分降低,差异有统计学意义(P<0.05)。结论改良CDT可改善中重度LLL,缓解焦虑抑郁情绪,且治疗效果优于传统CDT,不仅治疗效果优于对照组,在提高临床治疗效率上优于对照组改良消肿疗法,值得在临床推广应用。

Objective To study the therapeutic effect of modified complex decongestion therapy(CDT)on moderate to severe lower limb lymphedema(LLL)after gynecological pelvic tumor surgery.Methods A total of 78 patients with moderate to severe LLL after gynecological pelvic tumor surgery were randomly divided into control group(n=39)and modified group(n=39).The control group was treated with traditional CDT,including manual lymphatic drainage(MLD),multi-layer low-elastic bandage,functional exercise and self-skin care,and the modified group was given the same treatment except MLD that was replaced with a negative pressure lymphatic reflux promotion system.Before treatment and at 4 weeks after treatment,the circumference of the affected limb was measured by measuring tape,and the lower limb volume(LLV)was calculated.The lymphedema-related symptom scale was used to evaluate the symptoms of lymphedema,and the extracellular water ratio was measured by the multi-frequency bioelectrical impedance body composition analyzer.Ultrasound imaging was used to detect thickness of full-thickness skin,subcutaneous tissue thickening,deep fascia thickening,subcutaneous tissue echo score,and subcutaneous tissue morphology score,and Hospital Anxiety and Depression Scale(HADS)score was used to evaluate the patient′s emotion.Results Compared with those before treatment,at 4 weeks after treatment,patients in the control group and the modified group had reduced limb circumference,LLV and extracellular water ratio,improved lymphedema symptoms,increased skin thickness,thickened subcutaneous tissue and deep fascia,subcutaneous tissue echo score,decreased subcutaneous tissue morphology score,and decreased anxiety score and depression score,suggesting significant difference(P<0.05).Compared with the control group after treatment,patients in the modified group had reduced limb circumference,LLV,and extracellular water ratio,improved lymphedema symptoms,thickened deep fascia,decreased subcutaneous tissue echo scores,and decreased anxiety scores and depression scores,and the difference was statistically significant(P<0.05).Conclusion The modified CDT can improve moderate to severe LLL,and relieve anxiety and depression,and the therapeutic effect is better than that of traditional CDT and that in the control group.In addition,it is better than modified CDT in the control group with respect to improving the clinical treatment efficiency,which,therefore,is worthy of clinical application.