Lymphovenous anastomosis and complex decongestive therapy for severe deformed lymphedema with recurrent infection:A case report

BACKGROUND Lower extremity lymphedema is a common complication following treatment for gynecological malignancies.Its incidence rate can reach up to 70%,affecting~20 million people worldwide.However,specialized treatment centers are scarce,and there is a lack of consensus on treatment approaches.Furthermore,there are even fewer reports on the systematic and effective treatment of severe lymphedema with malformations.Effective management of this condition remains a significant challenge for clinicians.CASE SUMMARY A 40-year-old woman developed bilateral leg swelling 6 years after receiving treatment for endometrial cancer.Since August 2018,she experienced>30 episodes of lymphangitis.Upon presentation,she exhibited bilateral leg swelling and deformation,with four large swellings in the posterior thigh that impeded movement,and pain in the limbs.Skin manifestations included lichenoid lesions and features of deep sclerosis.Radionuclide lymphoscintigraphy confirmed the diagnosis of lower limb lymphedema.After 6 mo of complex decongestive therapy(CDT)and three lymphaticovenous anastomosis(LVA)treatments,the patient lost 49 kg in weight.She also experienced a maximum circumference reduction of 35.2 cm in the left lower limb and 37.5 cm in the right lower limb.The leg pain disappeared,her swelling significantly decreased,and she regained the ability to walk,cycle,and run normally.CONCLUSION The combined application of CDT and LVA therapy demonstrates significant positive effects in the treatment of severe,deformed stage III lymphedema.

Effectiveness of complex decongestive therapy in management of breast cancer associated lymphedema

Background:To assess the edema relief effects of complex decongestive therapy(CDT)in patients with breast cancer associated lymphedema after axillary lymph node dissection(ALND).Methods:58 breast cancer patients with unilateral arm lymphedema after breast cancer ALND were enrolled.The patients were divided into three groups based on the difference of circumference between the affected and unaffected extremity:group 1,mild lymphedema in circumference difference;group 2,moderate lymphedema,and group 3,severe lymphedema.These patients received four weeks of CDT and self-administered home therapy.Arm circumference was measured before,right after CDT,3 months and 12 months of follow-up.Results:In the first group,the circumference difference was 1.53±0.73 cm prior to CDT,and 0.32±0.59 cm right after CDT,and the difference was statistically significant(P<0.001).At the 1-year-follow-up,we got an even higher value than the pre-CDT one,however,there was no significant difference(P=0.175).At the end of CDT,the circumference difference of the third group was 4.52±2.58 cm,significantly lower than the baseline level(8.76±3.07 cm)(P<0.001).In the third group,the reduction of circumference difference was persisted for 12 months.Conclusion:The effects of CDT were maintained for 12 months,while there were differences in progress of circumference difference among the three groups.The effects of patients with severe initial edema(>5 cm increased)last longer.

Therapeutic Efficacy of Complex Decongestive Therapy in the Treatment of Elephantiasis of the Lower Extremities

Objective To evaluate the therapeutic efficacy of complex decongestive therapy in the treatment of elephantiasis of the lower extremities.Methods Seventeen patients with unilateral lower limb elephantiasis were included in the study(5 with primary lymphedema and 12 with secondary lymphedema).All patients were treated with one course(4 weeks)of complex decongestive therapy.Changes inextracellular fluid(ECF),BMI,circumferences,and skin properties including skin stiffness(SF),percent water content(PWC),and trans-epidermal water loss(TEWL)were measured before and after treatment.Results The“elephantiasis-like”appearance of the affected limb was greatly improved after treatment.The ECF,BMI,and circumferences were significantly decreased after treatment(P<0.001)with an average ECF of 2.97±1.82 L,BMI of 1.638±2.647 kg/m^2,and circumference of 6.58±2.79 cm.The values of PWC,TEWL,and SFwere 50.5%±10.6%,18.55±10.2 g/m^2 h,and 0.161±0.176 N,respectively,before treatment and 36.05%±7%,8.3±2.07 g/m^2h,and 0.086±0.038 N,respectively,after treatment,there by showing significant decreases(P<0.05).Conclusion Complex decongestive therapy is effective in the treatment of advanced stages of chronic lymphedema.

照护者参与乳腺癌相关淋巴水肿病人综合消肿治疗居家护理研究进展

针对照护者参与乳腺癌相关淋巴水肿病人综合消肿治疗居家护理现状以及影响因素进行综述,旨在为照护者参与乳腺癌相关淋巴水肿病人综合消肿治疗居家护理提供参考,缓解或消除病人淋巴水肿症状,改善其生活质量。

妇科恶性肿瘤术后继发Ⅲ期下肢淋巴水肿的护理

总结采用腰交感神经阻滞术和综合消肿治疗对4例妇科恶性肿瘤术后继发Ⅲ期下肢淋巴水肿患者进行治疗的护理经验,包括腰交感神经阻滞术的护理、个性化皮肤护理、改良的徒手淋巴引流、多层绷带加压包扎、患肢功能锻炼、饮食管理等。经过腰交感神经阻滞术和综合消肿治疗后,出院时患者患肢各部分周径减少,体重下降,皮肤变软,肢体功能受限得到缓解,水肿症状得到了有效控制。

Management of lymphedema is really a matter in patients with breast cancer

Lymphedema is a prevalent complication affecting patients with breast cancer,greatly impacting their quality of life.This editorial describes diagnostic methods and therapeutic interventions for managing lymphedema in patients with breast cancer.Diagnosis relies on clinical evaluation and objective measures,including arm circumference and volumetric assessments,along with lymphoscintigraphy and ultrasonic measurements.Treatment primarily involves complex decongestive physical therapy,comprising manual lymphatic drainage,compression therapy,exercise,and meticulous skin care.These interventions aim to reduce swelling,alleviate discomfort,and prevent further complications.Additionally,lifestyle modifications such as avoiding extreme temperatures and maintaining proper hygiene are essential.Flavonoids can be used for drug therapy.Despite its prevalence,lymphedema often receives inadequate attention in clinical practice,emphasizing the importance of raising awareness and enhancing medical services for affected individuals.Clinicians play a pivotal role in educating patients about preventive measures and ensuring timely intervention.Overall,a comprehensive approach encompassing early diagnosis,multidisciplinary management,and patient education is essential to mitigate the burden of lymphedema in patients with breast cancer and improve their overall well-being.

综合消肿疗法联合芒硝、大黄外敷对宫颈癌根治术后下肢淋巴水肿的干预效果

目的 探讨综合消肿疗法(CDT)联合芒硝、大黄外敷对宫颈癌根治术后下肢淋巴水肿(LLL)的干预效果,为临床护理提供参考。方法 采用前瞻性随机对照研究设计,选取2022年5月至2023年5月80例宫颈癌根治术后LLL患者按照随机数字表法分为试验组和对照组,每组40例。对照组实施常规术后护理和标准国际四步CDT,试验组在对照组基础上给予芒硝、大黄外敷。治疗前和治疗4周后,比较2组患者淋巴水肿分期、下肢周径以及生命质量的变化。结果 治疗4周后,试验组淋巴水肿程度较对照组减轻,且试验组大腿周径、小腿周径均低于对照组,差异有统计学意义(P<0.05)。治疗前,2组患者生命质量得分比较差异无统计学意义(P>0.05);治疗4周后,试验组生理状况、社会/家庭状况、情感状况、功能状况等维度得分以及生命质量总分均高于对照组,差异有统计学意义(P<0.05)。结论 CDT联合芒硝、大黄外敷治疗,可有效缓解宫颈癌根治术后下肢淋巴水肿,改善患者生命质量。

基于“以通为用”理论指导耳穴疗法对乳腺癌术后上肢淋巴水肿患者的干预效果研究

目的:评价基于“以通为用”理论指导耳穴疗法对乳腺癌术后上肢淋巴水肿患者的干预效果。方法:选取2021年3~12月在江苏省人民医院乳腺癌相关淋巴水肿(BCRL)护理门诊治疗的80例乳腺癌术后上肢淋巴水肿患者为研究对象,自意接受基于“以通为用”理论指导耳穴疗法联合综合消肿治疗(CDT)治疗的患者纳入干预组(40例),接受CDT治疗的患者纳入对照组(40例)。分别在治疗前1天、治疗后1、2、3个月比较两组患肢周径,治疗后3个月比较两组患侧上肢功能及生活质量评分情况。结果:对照组治疗3个月后上肢周径各指标均较治疗前下降(P<0.05)。干预组治疗2、3个月后上肢周径各指标(虎口指标除外)均较治疗前下降(P<0.05),干预组治疗3个月后上肢周径虎口指标较治疗前下降(P<0.05)。干预组治疗3个月后上肢周径各指标均较对照组下降(P<0.05),干预组治疗后的DASH评分低于对照组(P<0.05),生理状况、社会家庭状况、情感状况、功能状况、附加关注及生活质量总分等均高于对照组(P<0.05)。上肢功能障碍程度越高,生活质量评分越低(r=-0.538,P<0.001)。结论:基于“以通为用”理论指导耳穴疗法联合CDT对乳腺癌术后上肢淋巴水肿的治疗相较于CDT治疗更加有效,可供临床参考。

Study on the correlation between bandage bandage and pressure therapy of lymphedema

To explore the effects of bandage technology and pressure therapy in breast cancer with lymphedema.Methods A total of 91 patients,with breast cancer-related lymphedema and hospitalized in a third-class hospital in Jiangsu Province from May to December,2018,were selected and sequenced in class“ABC”in the order of entry.The patients in class“A”were enrolled in“8”shaped bandaging group.The patients in class“B”were enrolled in“5”spiral bandaging group.The patients in class“C”were enrolled in combined bandage group.The primary outcome was the degree of limb swelling used by multiple-frequency bioelectrical impedance analysis.Secondary outcomes were the amount of bandage losses,counting 24-hour bandage loose occurrences and patients satisfaction.All outcomes were evaluated both before and after treatment.Results After treatment,there was a significant difference in the regression of limb swelling in all three groups(P<0.05).However,the largest amplitude of regression was observed in combined bandage group(limb circumference ratio:53%and tissue water ratio:68%).Although“8”bandaging group had large material,bandage cost and minimum comfort,the bandage has good stability and no case of 24-hour bandage loose occurrences was found in this group.The“5”partial binding group had an advantage in the amount of bandage losses and comfort level,but among which 3 patients had the phenomenon of loose bandage at the joint.The combined bandage group had the best therapeutic effect in limb swelling and patients satisfaction(P<0.05).Conclusion The combined bandage group significantly decreased the degree of limb swelling and 24-hour bandage loose occurrences.Importantly,this treatment improved the degree of patients’satisfaction.The treatment of“8”shaped bandaging combined with spiral bandaging is worthy of clinical promotion.

中药湿热敷联合穴位按摩在中重度乳腺癌术后上肢淋巴水肿患者中的应用

目的 分析中药湿热敷联合穴位按摩在中重度乳腺癌术后上肢淋巴水肿患者中的应用效果。方法选取2019年3月至2021年12月于上海中医药大学附属第七人民医院接受综合消肿治疗的80例中重度乳腺癌术后上肢淋巴水肿患者作为研究对象。采用随机数字表法将其分为观察组与对照组每组各40例。对照组给予综合消肿治疗,观察组在对照组基础上增加中药湿热敷联合穴位按摩,共干预28 d。比较两组患者的患肢臂围周径、上肢功能活动度及乳腺癌淋巴水肿症状指数。结果 观察组患者的患肢臂围周径干预前后差值、干预后上肢功能活动度评分均低于对照组(P<0.05)。干预前,两组患者乳腺癌淋巴水肿症状指数两部分及其维度评分比较,差异均无统计学意义(P>0.05)。干预后,两组患者在乳腺癌淋巴水肿的症状个数、症状严重程度、症状困扰方面比较,差异有统计学意义(P<0.05),观察组优于对照组;其中,症状困扰的功能、社交、情绪及归属感维度得分比较,差异均有统计学意义(P<0.05),但性生活、睡眠维度得分比较,差异无统计学意义(P>0.05)。结论 通过中药湿热敷联合穴位按摩对中重度乳腺癌术后上肢淋巴水肿患者进行干预,可以有效缓解患者患肢肿胀、增加上肢功能活动度及减轻相关症状。

肿瘤医院淋巴水肿专科护理小组的建立与临床实践

目的 规范淋巴水肿专科护理方法,为患者提供专业化、同质化与系统化的淋巴水肿专科护理。方法 建立全院性淋巴水肿专科护理小组,制定小组工作职责、实施专科质量控制,进行包括专科护理门诊、分组手法引流综合消肿治疗、个案管理与延续护理、院内外问诊与会诊的临床工作与培训教学工作的规范化运行管理。结果 近3年淋巴水肿康复中心门诊量达4 550例,网络会诊量1 532例,手法引流综合消肿治疗量3 753例次;调查2 600例手法引流综合消肿治疗患者,满意度为96.84%。结论 淋巴水肿专科护理小组的运行管理模式较好地满足了淋巴水肿患者的康复需求,推进了淋巴水肿专科护理的发展。

知信行模式在乳腺癌术后上肢淋巴水肿综合消肿治疗患者中的应用

目的 探讨知信行模式在乳腺癌术后上肢淋巴水肿综合消肿治疗患者中的应用。方法 选取2018年1月至2020年1月在我院就诊诊断为上肢淋巴水肿的乳腺癌术后患者96例,随机分为两组各48例。对照组在淋巴水肿综合消肿治疗上实施常规健康教育,干预组在对照组基础上采用知信行模式干预,比较两组的淋巴水肿反弹情况。结果 干预12个月后,对照组有8例淋巴水肿反弹(占16.67%),干预组仅有1例淋巴水肿反弹(占2.08%),两组比较差异有统计学意义(P﹤0.05)。结论 乳腺癌术后上肢淋巴水肿综合消肿治疗患者采用知信行模式干预,可提高患者治疗依从性,有效维持治疗效果,降低淋巴水肿反弹率,提高患者的生活质量和满意度。

指状绷带不同包扎手法在乳腺癌术后手背部Ⅲ级淋巴水肿中的应用效果

目的:探讨指状绷带不同包扎手法在乳腺癌术后手背部Ⅲ级淋巴水肿中的应用效果。方法:选取2020年10月—2021年5月于江门市中心医院就诊的乳腺癌术后患肢手背部Ⅲ级淋巴水肿患者65例为研究对象,根据随机数字表法分为常规组(33例)和改进组(32例)。两组均进行淋巴水肿综合消肿治疗(CDT),常规组采用腕横纹包扎法进行指状绷带包扎,改进组采用虎口包扎法进行指状绷带包扎。比较两组患肢虎口周径、腕横纹周径、主观症状情况。结果:治疗前、治疗5次、治疗10次,两组患肢虎口周径比较,差异无统计学意义(P>0.05);治疗前,两组患肢腕横纹周径比较,差异无统计学意义(P>0.05);改进组治疗15、20次患肢虎口周径及治疗5、10、15、20次患肢腕横纹周径小于常规组,差异有统计学意义(P<0.001)。治疗前,两组肿胀、疼痛、麻木、手掌活动受限、紧绷发生率比较,差异无统计学意义(P>0.05);治疗后,改进组肿胀、疼痛、麻木、手掌活动受限、紧绷发生率低于常规组,差异有统计学意义(P<0.001)。结论:在乳腺癌术后患肢手背部Ⅲ级淋巴水肿患者CDT治疗中,采用虎口包扎法进行指状绷带包扎能够更好地贴合患者的患肢,促进淋巴液回流,从而改善水肿情况,缓解患者的主观症状。

乳腺癌术后淋巴水肿中西医结合诊治中国专家共识

乳腺癌手术及放化疗后,淋巴结和淋巴管的破坏会引起淋巴回流通路受阻,导致富含蛋白的淋巴液在软组织中积聚,出现上肢和腋窝的肿胀,进而引发肢体畸形、活动功能障碍及焦虑、抑郁、烦躁等心理问题。该病虽然不能治愈,但通过积极的消肿治疗、专业的护理和长期的康复治疗,水肿的症状可以得到长期缓解,患者的社会需求和心理需求可以得到长期满足。本专家共识从淋巴水肿的流行病学与病因、发病机制及病理生理学改变、中医学认识、相关高危因素、分期及分级、诊断及鉴别诊断、中西医防治手段及护理等多个方面进行探索分析.

阶段式综合康复方案在乳腺癌相关淋巴水肿患者中的应用研究

目的:分析阶段式综合康复方案在乳腺癌相关淋巴水肿患者中的应用效果,为促进乳腺癌相关淋巴水肿患者康复提供参考。方法:采用类实验研究方法,将2022年1月—6月于浙江省某三级甲等医院淋巴水肿护理门诊就诊的33例乳腺癌相关淋巴水肿患者设置为对照组,采用常规护理管理模式;将2022年7月—12月就诊的36例患者设置为实验组,在对照组基础上采用阶段式综合康复方案进行干预。干预前后分别测量两组患者生物电阻抗、患肢握力、上肢功能障碍及家庭亲密度与适应性等指标并进行比较。结果:干预后,实验组患者较对照组在体质量指数、患肢节段水分含量、患肢生物电阻抗、患肢握力、上肢功能障碍及家庭亲密度与适应性等指标上明显更优,差异均具有统计学意义(P<0.05)。结论:阶段式综合康复方案在乳腺癌相关淋巴水肿患者中的应用效果明显,对于缓解上肢淋巴水肿、改善肢体功能障碍、提升家庭亲密度等方面具有重要意义,值得将其推广于临床护理工作中。

火龙罐联合综合消肿治疗双下肢Ⅲ期合并外阴部Ⅱ期淋巴水肿1例的护理

本文总结1例龙罐联合综合消肿治疗双下肢Ⅲ期合并外阴部Ⅱ期淋巴水肿1例的护理经验。完善护理评估,在手法淋巴引流、多层低弹力绷带压力包扎、皮肤护理、运动锻炼等基础上,基于中医辨证,采用火龙罐、情志护理等中医护理干预,促进淋巴液回流,减轻水肿,预防感染。

地奥司明联合综合消肿疗法治疗宫颈癌术后下肢淋巴水肿的临床研究

目的:探讨地奥司明联合综合消肿疗法改善宫颈癌术后下肢淋巴水肿的效果。方法:选取2019年12月—2022年7月就诊的120例宫颈癌术后下肢淋巴水肿病人为研究对象,采用随机数字表法将其分为对照组、观察组各60例。对照组接受淋巴水肿常规护理和地奥司明治疗,观察组在对照组的基础上行手法淋巴引流、压力治疗等联合措施。治疗时间为3周,观察两组病人淋巴水肿相关症状、患肢周径和生活质量的改变情况。结果:干预后两组病人患肢周径、淋巴水肿相关症状评分均降低,观察组降低更明显(P<0.05);干预后观察组病人生活质量各维度得分均高于对照组(P<0.05)。结论:地奥司明联合综合消肿疗法治疗宫颈癌术后下肢淋巴水肿效果较佳,从生理、心理、社会等多个层面改善病人的生活质量。

胸导管探查术后综合消肿治疗对双下肢淋巴水肿患者的短期效果

目的评估胸导管探查术后运用综合消肿治疗对双下肢淋巴水肿患者的治疗效果。方法回顾2018年10月至2022年9月就诊的25例双下肢淋巴水肿患者的临床资料。将胸导管探查术后行综合消肿治疗的患肢作为干预组,未行综合消肿治疗的对侧肢体作为对照组。治疗前和治疗后第7天,测量肢体周径和进行人体成分分析。结果患肢行综合消肿治疗7 d后,患肢的小腿中下1/3、小腿中上1/3、大腿中下1/3、大腿中上1/3测量点周径均明显减小(P<0.05);干预组小腿中下1/3和小腿中上1/3周径的变化率明显大于对照组(P<0.05);与治疗前相比,对照组治疗后节段细胞外水分含量变化差异无统计学意义(P>0.05),而干预组治疗后节段细胞外水分含量明显降低(P<0.05)。结论胸导管探查术后运用综合消肿治疗对双下肢淋巴水肿患者有良好的治疗效果。

手法淋巴引流综合消肿疗法在妇科肿瘤淋巴水肿中的临床应用

目的探讨手法淋巴引流综合消肿疗法(CDT)治疗妇科肿瘤淋巴水肿的临床效果。方法采用随机数字表法将60例妇科肿瘤淋巴水肿患者分为对照组和观察组,每组30例。对照组患者采用空气波压力治疗,观察组患者在对照组的基础上采用CDT治疗。比较两组患者缓解情况、患肢最大周径、主观症状体征变化、组织水分率及生活质量。结果观察组患者总缓解率高于对照组,差异有统计学意义(P﹤0.05)。治疗后,不同程度水肿的两组患者患肢最大周径均小于本组治疗前,且不同程度水肿的观察组患者患肢最大周径均小于对照组,差异均有统计学意义(P﹤0.05)。治疗后,两组患者妇科恶性肿瘤淋巴水肿问卷表(GCLQ)评分、组织水分率均低于本组治疗前,且观察组患者GCLQ评分、组织水分率均低于对照组,差异均有统计学意义(P﹤0.05)。治疗后,两组患者总体健康、功能状况评分均高于本组治疗前,症状评分均低于本组治疗前,且观察组患者总体健康、功能状况评分均高于对照组,症状评分低于对照组,差异均有统计学意义(P﹤0.05)。结论CDT治疗妇科肿瘤术后淋巴水肿可取得较好效果,且安全、无创、操作简单,可行性高。

基于综合消肿治疗的协同护理模式在乳腺癌术后上肢淋巴水肿患者居家管理中的应用

目的:探讨基于综合消肿治疗(CDT)的协同护理模式在乳腺癌术后上肢淋巴水肿患者居家管理中的应用效果。方法:选取2021年1月—2022年12月南京医科大学附属江苏盛泽医院收治的女性乳腺癌改良根治术后上肢淋巴水肿患者76例为研究对象,根据随机数字表法分为对照组和试验组,各38例。两组均行CDT治疗,对照组行常规护理,试验组行协同护理模式。比较两组患肢周径比率、依从性及满意度。结果:出院后12、24周,试验组患肢周径比率低于对照组,差异有统计学意义(P<0.05);出院后4、12、24周,试验组治疗依从性高于对照组,差异有统计学意义(P<0.05);出院后12、24周,试验组满意度高于对照组,差异有统计学意义(P<0.05)。结论:基于CDT的协同护理模式能有效改善乳腺癌术后淋巴水肿,提高患者治疗依从性及满意度。