防己黄芪汤化裁外敷联合温针灸治疗乳腺癌术后上肢淋巴水肿疗效观察

Effect of external application of modified Fangji Huangqi Decoction combined with needle warming moxibustion on breast cancer related lymphedema

目的观察防己黄芪汤化裁外敷联合温针灸治疗乳腺癌术后上肢淋巴水肿(BCRL)的效果。方法将我院104例BCRL患者随机分为对照组与观察组各52例,对照组给予功能训练指导及地奥司明片治疗,观察组在对照组的治疗基础上予以防己黄芪汤化裁外敷联合温针灸治疗,比较两组临床疗效、中医证候积分、患肢周径、上肢患-健侧周径差、上肢功能评分(DASH)及血清肿瘤侵袭因子[血管内皮生长因子(VEGF)、基质金属蛋白酶-2(MMP-2)、基质金属蛋白酶-9(MMP-9)]水平,记录两组不良反应发生情况。结果治疗后,观察组总有效率显著高于对照组(P<0.05);两组中医证候主症积分、患肢上臂围、前臂围以及上肢患-健侧周径差、DASH评分和血清VEGF、MMP-2及MMP-9水平均低于治疗前,观察组上述指标均低于对照组(P<0.05);观察组不良反应总发生率低于对照组(P<0.05)。结论采用防己黄芪汤化裁外敷联合温针灸治疗BCRL患者疗效良好,能明显减轻相关症状,改善上肢淋巴水肿情况,提高上肢功能,并降低血清肿瘤侵袭因子水平,促使疾病好转。

Objective To observe the effect of external application of modified Fangji Huangqi Decoction combined with needle warming moxibustion on breast cancer related lymphedema(BCRL).Methods A total of 104 BCRL patients were randomly divided into control group and observation group,with 52 cases in each group.Control group was given functional training guidance and diosmin tablets treatment,while observation group was treated with external application of modified Fangji Huangqi Decoction combined with needle warming moxibustion on the basis of control group.The efficacy in the two groups was evaluated.The TCMprimary symptoms scores,circumference of the affected limb,circumference difference between the affected and healthy sides of the upper limb,Disability of Arm-Shoulder-Hand(DASH)and serum tumor invasion factors[vascular endothelial growth factor(VEGF),matrix metalloproteinase-2(MMP-2),MMP-9]were compared between the two groups,and the adverse reactions in the two groups were recorded.Results After treatment the total effective rate in observation group was significantly higher than that in control group(P<0.05).Compared with before treatment,the scores of TCM primary syndromes and fatigue and weakness,affected arm circumference,forearm circumference,circumference difference between the affected and healthy sides and levels of serum VEGF,MMP-2 and MMP-9 in both groups were lower(P<0.05),and the above indicators in observation group were lower than those in control group(P<0.05);the total incidence rate of adverse reactions in observation group was significantly lower than that in control group(P<0.05).Conclusion External application of modified Fangji Huangqi Decoction combined with needle warming moxibustion has good efficacy in treatment of BCRL.It can significantly reduce the related symptoms,significantly improve the upper limb lymphedema,enhance the upper limb function,and reduce the levels of serum tumor invasion factors,so as to promote the improvement of the disease.