A Fractional-Order Ultra-Local Model-Based Adaptive Neural Network Sliding Mode Control of n-DOF Upper-Limb Exoskeleton With Input Deadzone

This paper proposes an adaptive neural network sliding mode control based on fractional-order ultra-local model for n-DOF upper-limb exoskeleton in presence of uncertainties,external disturbances and input deadzone.Considering the model complexity and input deadzone,a fractional-order ultra-local model is proposed to formulate the original dynamic system for simple controller design.Firstly,the control gain of ultra-local model is considered as a constant.The fractional-order sliding mode technique is designed to stabilize the closed-loop system,while fractional-order time-delay estimation is combined with neural network to estimate the lumped disturbance.Correspondingly,a fractional-order ultra-local model-based neural network sliding mode controller(FO-NNSMC) is proposed.Secondly,to avoid disadvantageous effect of improper gain selection on the control performance,the control gain of ultra-local model is considered as an unknown parameter.Then,the Nussbaum technique is introduced into the FO-NNSMC to deal with the stability problem with unknown gain.Correspondingly,a fractional-order ultra-local model-based adaptive neural network sliding mode controller(FO-ANNSMC) is proposed.Moreover,the stability analysis of the closed-loop system with the proposed method is presented by using the Lyapunov theory.Finally,with the co-simulations on virtual prototype of 7-DOF iReHave upper-limb exoskeleton and experiments on 2-DOF upper-limb exoskeleton,the obtained compared results illustrate the effectiveness and superiority of the proposed method.

Effects of Alexithymia to Stigma of Patients with Lymphedema

BACKGROUND: Secondary lymphedema is one of the common complications after malignant tumor surgery. It is a chronic and complex disease. Once lymphedema occurs, there will be discomfort such as limb swelling, pain, numbness and tension, which will eventually lead to changes in the appearance of the affected limb and will seriously affect the quality of life and require lifelong treatment and psychosocial support. This study investigated the current situation of stigma and alexithymia in patients with lymphedema, and discussed the impact of alexithymia on stigma in patients with lymphedema. AIMS: To understand the current situation of stigma and alexithymia in patients with lymphedema, and to analyze the influence of alexithymia on stigma. METHODS: 195 patients with lymphedema in a hospital were selected by convenient sampling. General information questionnaire, Toronto Alexithymia Scale and social impact scale were used to investigate respectively, to study the general situation, stigma and alexithymia of the respondents. RESULTS: The results showed that the total score of stigma in 195 patients with lymphedema was (60.36 ± 11.08), and the total score of alexithymia was (56.53 ± 8.43). Multiple linear regression analysis showed that alexithymia and family relationship were the influencing factors of stigma in patients with lymphedema. CONCLUSIONS: The patients with lymphedema have obvious stigma, and alexithymia and family relationship are the influencing factors.

Preprocessing and Efficacy Analysis of Comprehensive Anti-Inflammatory Treatment for Lymphedema in Patients with Irritating Contact Dermatitis

Objective: To explore the pre-treatment and efficacy analysis of comprehensive anti-inflammatory treatment for lymphedema in patients with irritating contact dermatitis. Method: Convenience sampling method was used to observe the skin of 160 patients with upper limb lymphedema admitted to the lymphedema outpatient department of our hospital. They were divided into an observation group (80 cases) and a control group (80 cases), and both groups received a course of comprehensive anti-inflammatory treatment (20 treatments). The control group received routine skin care;On the basis of the control group, the observation group received pre-treatment of the affected limb skin: Laofuzi herbal ointment was applied externally to the prone areas of irritating contact dermatitis (such as the upper arm, inner forearm, and cubital fossa). Result: The incidence of irritating contact dermatitis in the observation group was significantly lower than that in the control group (P 0.05). Patients in the observation group felt significantly better in terms of comfort, skin moisture, and itching relief after being wrapped with low elasticity bandages than those in the control group (P Conclusion: Preventive treatment can effectively reduce the incidence of irritating contact dermatitis, prolong the time of stress treatment, thereby increasing efficacy and improving patient compliance.

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.

Tuberous sclerosis complex combined with primary lymphedema:A case report

BACKGROUND Tuberous sclerosis complex(TSC)and primary lymphedema(PLE)are both rare diseases,and it is even rarer for both to occur in the same patient.In this work,we have provided a detailed description of a patient's clinical presentation,imaging findings,and treatment.And a retrospective analysis was conducted on 14 published relevant case reports.CASE SUMMARY A 16-year-old male came to our hospital for treatment due to right lower limb swelling.This swelling is already present from birth.The patient’s memory had been progressively declining.Seizures had occurred 1 year prior at an unknown frequency.The patient was diagnosed with TSC combined with PLE through multimodal imaging examination:Computed tomography,magnetic resonance imaging,and lymphoscintigraphy.The patient underwent liposuction.The swelling of the patient's right lower limb significantly improved after surgery.Epilepsy did not occur.after taking antiepileptic drugs and sirolimus.CONCLUSION TSC with PLE is a rare and systemic disease.Imaging can detect lesions of this disease,which are important for diagnosis and treatment.

Vascularized lymph node transfer using axilla as recipient site restores lymphatic flow in upper limb lymphedema:Evidence from magnetic resonance lymphangiography

Background:Lymphedema is a debilitating condition that frequently occurs after breast cancer treatment.Vas-cularized lymph node transfer(VLNT)is a promising approach to reduce lymphedema.This study used magnetic resonance lymphangiography(MRL)to assess lymphatic reconnections post-VLNT in patients with breast cancer-related lymphedema(BCRL).Methods:The clinical records of six female patients with unilateral upper limb BCRL who underwent VLNT(4 cases)or VLNT combined with breast reconstruction(2 cases)were retrospectively reviewed.All patients were examined using MRL preoperatively and at the 1-year follow-up.The morphological characteristics of the lymphatic network,dermal backflow patterns,and architecture of the lymph nodes were evaluated.Clinical outcomes,patient satisfaction,and complications were assessed.Results:At the 1-year follow-up,reduction in tissue edema and limb circumference was achieved in all six patients.In MRL,the implanted lymph nodes in the axillary region of the affected upper arm were enhanced and visualized in all six patients.Reconnected lymphatic vessels in the subcutaneous tissue associated with the implanted lymph nodes were observed in four patients.Decreased dermal backflow and lymphatic vessel dilation of the affected limbs were observed in all six patients.No disruption of the lymph flow in the donor area was detected.Conclusion:This is the first study to provide direct imaging evidence for the reconnection of afferent lymphatic channels between implanted lymph nodes and the recipient lymphatic system in patients with BCRL.Overall,our study demonstrates the mechanism and efficacy of VLNT in reducing lymphedema.

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.

Efficacy and effect on serum VEGF-C of mild moxibustion plus functional exercise for upper-limb lymphedema after breast cancer surgery

Objective To observe the efficacy of mild moxibustion combined with functional exercise in the treatment of upper-limb lymphedema after breast cancer surgery and its effect on serum vascular endothelial growth factor C(VEGF-C).Methods Seventy-eight patients were divided into a control group and an observation group by the random number table method,with 39 cases in each group.The control group received functional exercise and the observation group received mild moxibustion plus functional exercise.The differences in circumference between the two upper limbs,the lymphatic flow of the affected upper limb,the disability of arm,shoulder and hand(DASH)score,the functional assessment of cancer therapy-breast(FACT-B)score and serum VEGF-C level between the two groups were compared before and after treatment.Efficacy was evaluated after treatment.Results The total effective rate was significantly higher in the observation group than in the control group(P<0.05).The difference in circumference between the two upper limbs of the two groups decreased significantly after treatment(both P<0.05),but it was significantly lower in the observation group than in the control group(P<0.05).The lymphatic flow of the affected upper limb of the two groups increased significantly after treatment(both P<0.05),but it was significantly greater in the observation group than in the control group(P<0.05).The DASH scores of the two groups decreased significantly after treatment(both P<0.05),but it was significantly lower in the observation group than in the control group(P<0.05).The FACT-B scores of the two groups increased significantly after treatment(both P<0.05),but it was significantly higher in the observation group than in the control group(P<0.05).After treatment,the serum VEGF-C level increased significantly in the observation group(P<0.05),whereas the control group did not show significant change(P>0.05).The post-treatment serum VEGF-C level was significantly higher in the observation group than in the control group(P<0.05).Conclusion The efficacy of mild moxibustion combined with functional exercise for upper-limb lymphedema after breast cancer surgery is certain,which can reduce the difference in circumference between the two upper limbs,increase the lymphatic flow of the affected upper limb,improve the limb function and the quality of life,and regulate the serum VEGF-C level.

乳腺癌术后患者上肢淋巴水肿预防方案的构建及应用研究

目的构建乳腺癌术后患者上肢淋巴水肿预防方案并评价其效果。方法在证据总结和半结构式访谈的基础上,构建乳腺癌术后患者上肢淋巴水肿预防方案初稿,于2022年12月进行2轮专家函询。采用便利抽样法,选取郑州市某三级甲等医院乳腺外科恶性肿瘤手术患者为研究对象,根据首次就诊时间,将2023年1月—3月收治的58例患者纳入试验组,实施乳腺癌术后患者上肢淋巴水肿预防方案。将2022年7月—12月收治的57例患者纳入对照组,予以常规护理。比较两组出院后1、3、6个月淋巴水肿发生率、上肢功能得分、淋巴水肿预防行为依从性得分。结果2轮函询问卷的有效回收率分别为92.59%、100%,专家权威系数分别为0.940、0.950,肯德尔和谐系数分别为0.228、0.254(均P<0.001)。第2轮函询的变异系数为0.07~0.24。方案终稿包括一级指标5项、二级指标12项、三级指标32项。方案应用过程中,共脱落5例,试验组和对照组各纳入55例。重复测量方差分析结果显示,两组干预前和出院后1、3、6个月的上肢功能得分、淋巴水肿预防行为依从性得分的时间与组间存在交互效应(P<0.05);简单效应分析显示,出院后1、3、6个月,试验组的上肢功能得分、淋巴水肿预防行为依从性得分均优于对照组,差异具有统计学意义(P<0.05)。出院后6个月,两组淋巴水肿发生率比较,差异有统计学意义(P=0.032)。两组均未发生皮下淤血、跌倒等不良事件。结果该研究构建的乳腺癌术后患者上肢淋巴水肿预防方案具有科学性、可行性及安全性,可有效降低患者淋巴水肿的发生率,提高患者的生活质量。

The Risk Factors of Lymphedema in Breast Cancer Patients Post Axillary Clearance

Introduction: Breast cancer is the number one malignancy affecting females in Saudi Arabia with a prevalence of 22.4%. Breast cancer incidence increases annually due to the aid of established screening programs, leading to the discovery of breast cancer in its early stages. Surgical treatment is an integral part of early breast cancer management to achieve local control. Axillary surgical interventions such sentinel lymph node biopsy (SLNB) and axillary lymph node clearance (ALND) aim to stage the axilla as an adjunct to the management of the primary breast tumor. In this paper, we reviewed female breast cancer patients aged 30 - 60 who underwent surgical treatment of SLNB and/or ALND with reporting the prevalence of lymphedema and other associated complications and risk factors. Methodology: A cross-sectional non-interventional study, with a sample size of 250 including breast cancer cases from 2016 to 2019 at National Guard Hospital (NGH) in Jeddah, Saudi Arabia. Results: A total of 253 breast cancer cases were included in this study, with a mean age of 53 years, 52.7% were postmenopausal and positive family history was present among 21% of cases. Further, 90.9% of the cases had unilateral disease. Staging was as follows: stage I 14.5%, stage II 45.2%, stage III 37.1%, and stage IV 3.2%. Mastectomy was done in 73.4% cases and lumpectomy was performed in 34.1% of cases. In addition, 93.3% of patients had SLNB and 49% of them were positive. Axillary dissection was performed in 69.6% of our patients. Radiotherapy and chemotherapy were given to 71.8% and 80.4% of cases respectively. Among the chemotherapy (chemo) recipients, 40.2% received adjuvant chemo, 54.5% received neoadjuvant chemo, and the remaining 5.3% received both. Further, the most prevalent complication was pain accounting for 42.1% of total complications, and the least prevalent was cellulitis 4%. Also, seroma developed in 18.3% cases, paresthesia noted in 5.6% of cases, winged scapula was reported as 2%, weakness and necrosis were seen in 6% and 13.1% of cases respectively. Axillary vein thrombosis and lymphangiosarcoma were reported in none of the patients (0%). Lymphoedema accounted for 16.1% of overall complications, 85% of the patients who developed lymphedema had undergone ALND, and 12.9% and 14.4% received radiotherapy and chemotherapy respectively. Lymphedema was observed in breast cancer stages as follows: stage I 1.2%, stage II 7.2%, and stage III 5.2%. Patients with body mass index (BMI) of 30 - 39 kg/m2 had 7.2% prevalence of lymphedema compared to other BMI groups. Overall mortality was 8.3%. Conclusion: The findings of our study suggest that the prevalence of lymphedema was higher in ALND patients with locally advanced tumors, and higher BMI, compared to patients with stage I breast cancer and low BMI. Further, the prevalence of lymphedema in patients who underwent ALND was significantly lower than those who were treated by lumpectomy 10.3% (p-value = 0.034) in comparison to mastectomy 19.3%.

穴位按摩联合艾灸治疗乳腺癌术后上肢淋巴水肿临床研究

目的:观察穴位按摩联合艾灸治疗乳腺癌术后上肢淋巴水肿的临床疗效。方法:采用随机数字表法将80例乳腺癌术后上肢淋巴水肿患者分为对照组、治疗组各40例。2组均给予地奥司明片治疗,对照组加用按摩与上肢功能锻炼治疗,治疗组加用穴位按摩联合艾灸治疗,2组连续治疗8周。比较2组临床疗效及治疗前后腺癌淋巴水肿症状体验指数(BCLE-SEI)、淋巴水肿纤维化分级、视觉模拟评分法(VAS)肿胀、VAS疼痛、乳腺癌患者生命质量测定量表(FACT-B)评分及上肢活动度。结果:治疗后,治疗组总有效率95.00%,高于对照组80.00%(P<0.05)。治疗后,2组中医证候积分、BCLE-SEI评分、淋巴水肿纤维化分级评分、VAS肿胀评分、VAS疼痛评分、FACT-B维度(生理、社会/家庭、情感、功能及其他状况)评分均较治疗前降低(P<0.05),且治疗组治疗后上述指标均低于对照组(P<0.05)。治疗后,2组上肢上举、内旋、外旋、水平屈曲及水平伸展活动度均较治疗前增大(P<0.05),且治疗组治疗后上述5项活动度高于对照组(P<0.05)。结论:穴位按摩联合艾灸治疗乳腺癌术后上肢淋巴水肿疗效确切,能够减轻患者患肢水肿和疼痛程度,促进上肢功能恢复,提高生活质量。

多元化延续性干预在乳腺癌术后上肢淋巴水肿康复中的应用效果

目的分析多元化延续性干预在乳腺癌患者术后上肢淋巴水肿康复中的应用效果。方法根据干预方法的不同将96例乳腺癌手术患者分为对照组(n=47)和研究组(n=49),对照组患者采用常规干预,研究组患者在对照组的基础上采用多元化延续性干预。比较两组患者的满意度、上肢功能活动情况[臂肩手功能障碍评估表(DASH)]、上肢淋巴水肿情况。结果研究组患者的总满意度为97.96%,明显高于对照组患者的80.85%,差异有统计学意义(P﹤0.01)。干预后,两组患者DASH评分均明显低于本组干预前,研究组患者DASH评分明显低于对照组,差异均有统计学意义(P﹤0.01)。干预后,研究组患者上肢淋巴水肿情况优于对照组(P﹤0.05)。结论多元化延续性干预可减轻乳腺癌患者术后上肢淋巴水肿,促进患者上肢功能恢复,提高满意度,值得临床推广应用。

黄甲综合征1例并文献复习

报道1例黄甲综合征患者的临床资料,并进行文献复习。

改良式简易锻炼法在乳腺癌术后患者康复中的应用

目的探究改良式简易锻炼法在乳腺癌术后患者康复中的应用效果.方法选择2022年3月—2023年2月于齐齐哈尔市第一医院乳腺二科行乳腺癌改良根治术的300例患者为研究对象,采用随机数字表法将其分为对照组与观察组,每组150例.术后,对照组采用传统康复锻炼法,观察组在此基础上采用改良式简易锻炼法,均持续干预3个月.比较两组患者的肩关节活动度、患肢淋巴水肿发生情况及严重程度、上肢功能.结果干预后,观察组的肩关节活动度优于对照组,差异有统计学意义(P﹤0.05);观察组的淋巴水肿发生率低于对照组,严重程度轻于对照组,组间差异有统计学意义(P﹤0.05);观察组的Fugl-Meyer上肢运动功能评定量表评分为(40.37±3.67)分,高于对照组的(31.34±3.40)分,差异有统计学意义(P﹤0.05).结论改良式简易锻炼法可有效提高乳腺癌术后患者的肩关节活动度,降低患肢淋巴水肿发生率,减轻水肿程度,改善上肢功能.

超声造影诊断下肢淋巴水肿的研究进展

下肢淋巴水肿是一种慢性、进行性疾病,严重影响患者生活质量;早期诊断和治疗可延缓病情进展,有利于改善患者预后。目前常见的下肢淋巴水肿诊断技术均具有一定的缺点而使应用受限。超声造影具有无创、便捷、实时、重复性好的特点,能够增强淋巴管中淋巴液的显像,对浅表淋巴管显像具有较高敏感度,近年来逐渐应用于下肢淋巴水肿诊断。本文对超声造影在下肢淋巴水肿中的应用情况进行综述。

不同部位注射吲哚菁绿示踪下肢淋巴回流通路及子宫旁淋巴回流通路观察

目的通过趾间注射与宫颈注射吲哚菁绿示踪,观察下肢淋巴回流通路和子宫旁淋巴回流通路的不同之处。方法选择2019年6月至2022年11月于周口市中心医院就诊的早期子宫内膜癌或宫颈癌患者50例为研究对象。根据术中吲哚菁绿注射的部位将患者分为趾间注射组(n=20)和宫颈注射组(n=30)。2组患者分别在趾间及宫颈注射吲哚菁绿,在荧光腹腔镜下观察下肢淋巴回流在盆腔内的通路以及子宫旁淋巴回流通路,重点观察二者的不同之处。结果趾间注射组患者(20例40侧)中下肢淋巴回流在盆腔段显影18例(33侧),2例双侧未显影。显影的患者中有26侧显示下肢淋巴回流经腹股沟深淋巴结、旋髂淋巴结、髂外淋巴结、髂总淋巴结,5侧显示下肢淋巴回流至腹股沟深淋巴结、旋髂淋巴结、闭孔淋巴结、髂内淋巴结、髂总淋巴结,2侧显示下肢淋巴回流至腹股沟深淋巴结、闭孔淋巴结、髂内淋巴结、髂总淋巴结。宫颈注射组患者(30例60侧)中盆腔内淋巴显影29例55侧,1例双侧未显影。显影的患者中2侧显示宫旁淋巴回流至闭孔淋巴结、旋髂淋巴结、髂外淋巴结、髂总淋巴结,其中旋髂淋巴结均为非前哨淋巴结;40侧显示宫旁淋巴回流沿着上宫颈旁淋巴回流通路至髂外内侧淋巴结(或闭孔淋巴结)、髂总淋巴结;13侧显示沿着下宫颈旁淋巴回流通路至髂内淋巴结或骶前淋巴结。下肢淋巴回流与子宫旁淋巴回流的共同引流途径是由闭孔、髂外、髂总淋巴向上回流。趾间注射组和宫颈注射组旋髂淋巴结显影率分别为93.94%(31/33)、3.63%(2/55),趾间注射组旋髂淋巴结显影率显著高于宫颈注射组(P<0.05)。结论应用吲哚菁绿示踪剂在荧光腹腔镜下能更直观地看到下肢淋巴回流及子宫旁淋巴回流通路,二者的淋巴回流不同之处在于下肢淋巴回流经髂外淋巴结远端的旋髂淋巴结,而宫颈癌和子宫内膜癌很少转移至此。

综合护理在乳腺癌术后上肢淋巴水肿中的应用效果

目的探讨综合护理在乳腺癌术后上肢淋巴水肿中的应用效果。方法选取2021年12月至2023年3月新疆医科大学第一附属医院收治的136例女性乳腺癌术后上肢淋巴水肿患者,按照随机数字表法分为两组,每组68例。对照组采取常规护理,观察组采取综合护理,比较两组上肢淋巴水肿知识知晓程度、护理依从性、术后3个月上肢淋巴水肿缓解情况,以及上肢运动能力、上肢疼痛、生活质量评分和满意度。结果观察组上肢淋巴水肿知识知晓优良率较对照组更高(P<0.05);观察组护理总依从率较对照组更高(P<0.05);观察组术后3个月上肢淋巴水肿缓解总有效率较对照组更高(P<0.05);护理后观察组上肢运动能力评分、生活质量评分较对照组更高,上肢疼痛评分较对照组更低(P<0.05);观察组护理总满意率较对照组更高(P<0.05)。结论综合护理在乳腺癌术后上肢淋巴水肿中应用,能够提高患者上肢淋巴水肿知识知晓程度、依从性及护理满意度,缓解上肢淋巴水肿,改善上肢运动能力与生活质量。

少毛症-淋巴水肿-毛细血管扩张-肾缺陷综合征

少毛症-淋巴水肿-毛细血管扩张症(hypotrichosis-lymphedema-telangiectasia syndrome,HLTS)是一种由SOX18基因变异引起的罕见的临床综合征性淋巴水肿疾病,为常染色体显性或隐性遗传性疾病,好发于新生儿期及婴儿期,其特征是早发性少毛症、淋巴水肿及毛细血管扩张,而少毛症-淋巴水肿-毛细血管扩张-肾缺陷综合征(HLT-renal defect syndrome,HLTRS)是伴有肾损害的HLTS,除有HLTS的临床特征外,还存在补体正常的膜增生性肾小球肾炎。虽HLTRS的患病率不足百万分之一,我国尚未有该病的相关报道,但考虑我国人口基数大,可能存在对该病认识不足情况,现对HLTRS的发病机制、诊断及治疗进行总结,以期提高对该病的认识。

手法淋巴引流联合“合穴”按摩综合治疗对肿瘤患者肢体淋巴水肿的影响

目的探讨手法淋巴引流联合“合穴”按摩综合治疗对肿瘤患者肢体淋巴水肿的影响。方法选择2022年6月至2023年12月在泰州市人民医院肿瘤科、妇科、乳腺外科病区住院的60例肢体淋巴水肿患者为研究对象,采用随机信封法将患者分为研究组和对照组各30例,对照组患者给予常规护理手法引流,研究组患者则开展常规护理手法引流联合“合穴”按摩综合治疗,对比两组治疗前后患肢与健肢水肿周径差值及肢体淋巴水肿治疗效果。结果研究组治疗前后肢体周径差值明显大于对照组,患者的肢体水肿情况改善明显,差异有统计学意义(P<0.05)。结论手法淋巴引流联合“合穴”按摩综合治疗对肿瘤患者肢体淋巴水肿改善效果好,能提高患者的生活质量,值得临床应用。

乳腺癌患者术后1年内发生患侧上肢淋巴水肿的危险因素分析

目的探讨乳腺癌患者术后1年内发生患侧上肢淋巴水肿的危险因素。方法收集2021年3月至2022年3月于首都医科大学附属北京朝阳医院接受手术治疗的370例乳腺癌患者的临床资料。根据术后1年随访期间是否发生患侧上肢淋巴水肿将患者分为水肿组(n=67)和对照组(n=303)。收集并比较两组患者手术之前的基本资料,采用多因素Logistic回归模型进一步分析乳腺癌患者术后1年内发生患侧上肢淋巴水肿的危险因素。结果水肿组患者单身比例、体重指数、肿瘤分期为Ⅲ期的比例、淋巴结清扫数目≥10个的比例及术后接受放疗的比例均高于对照组患者,但术后采取针对性预防措施的比例低于对照组患者,差异均有统计学意义(P﹤0.05)。多因素分析结果显示,单身、体重指数≥27 kg/m^(2)、肿瘤分期为Ⅲ期、淋巴结清扫数目≥10个及术后接受放疗均为乳腺癌患者术后1年内发生患侧上肢淋巴水肿的独立危险因素,而术后采取针对性预防措施是乳腺癌患者术后1年内发生患侧上肢淋巴水肿的保护因素(P﹤0.05)。结论体重指数、单身、肿瘤分期、淋巴结清扫数目、术后是否接受放疗以及术后是否采取针对性预防措施均与乳腺癌患者术后1年内发生患侧上肢淋巴水肿密切相关,临床实践中可据此筛查高危患者,并协助、教育患者坚持积极的预防措施。