徒手淋巴引流在乳腺癌术后淋巴水肿中应用效果的Meta分析

目的:评价徒手淋巴引流在乳腺癌患者术后淋巴水肿中的应用效果。方法:计算机检索Cochrane Library、PubMed、Web of Science、EMBASE、中国生物医学文献数据库、中国知网、万方和维普等国内外数据库中有关徒手淋巴引流应用于乳腺癌患者术后淋巴水肿的随机对照试验。经筛选文献,提取资料与评价文献质量后,采用RevMan 5.3软件进行Meta分析。结果:最终纳入11篇随机对照试验,共2524例患者。Meta分析结果显示,徒手淋巴引流可有效预防乳腺癌患者在术后12个月、6个月、3个月发生淋巴水肿[RR=0.35,95%CI(0.17,0.74),P<0.01;RR=0.45,95%CI(0.30,0.68),P<0.01;RR=0.24,95%CI(0.12,0.48),P<0.01],可有效减少乳腺癌患者术后淋巴水肿体积[WMD=-52.35,95%CI(-70.51,-34.19),P<0.01],可有效降低患者术后发生腋窝综合征的风险[RR=0.17,95%CI(0.09,0.34),P<0.01]。结论:徒手淋巴引流能有效预防和治疗乳腺癌患者术后淋巴水肿,以及有效预防腋窝综合征的发生,建议临床推广应用。     

循证护理实践推荐

正临床问题关于运动疗法管理淋巴水肿的最佳有效证据是什么?证据来源本证据总结基于系统检索循证卫生保健数据库。证据来源于:(1)两篇系统评价。(2)六篇随机对照试验。(3)一篇自身前后对照实验。最佳实践推荐·患有乳腺癌治疗相关的淋巴水肿的女性患者可以进行运动训练,并不会因此加重淋巴水肿症状。(Grade B)·在手术后的几周内早期开始运动增加的淋巴水肿发生率和延迟运动相比没有统计学差异。在早期的运动中,伤口的引流可能会增加,而伤口的愈合可能需要更长的时间。在进行化疗、放疗等癌症辅助     

标准化综合消肿疗法对乳腺癌术后淋巴水肿有效性的系统评价

目的系统评价标准化综合消肿疗法对乳腺癌术后淋巴水肿的有效性。方法计算机检索Cochrane Library、PubMed、EMBASE、Web of Science、CINAHL、维普数据库(VIP)、中国期刊全文数据库(CNKI)、万方数据库以及临床在研数据库www.clinicaltrials.gov中关于乳腺癌术后淋巴水肿综合消肿疗法的实验研究和类实验研究。由2名研究者使用澳大利亚JBI循证卫生保健中心的类试验研究评价工具对纳入文献分别独立进行评价,提取数据录入RevMan 5.2软件进行分析。结果共纳入11篇文献,均为类试验研究,总样本为871例淋巴水肿患者。结果显示:与治疗前相比,标准化综合消肿疗法可以有效减少乳腺癌水肿患者的水肿体积,差异具有统计学意义[MD=-368.85,95%CI(-465.53～-272.17),P0.001]。对患者疼痛及水肿肢体肩关节功能的影响通过描述性分析发现,标准化综合消肿疗法可有效减轻疼痛,改善肩关节功能。结论标准化综合消肿疗法对于乳腺癌术后淋巴水肿体积、疼痛及水肿肢体肩关节功能具有一定的积极影响。     

早期渐进性功能锻炼对乳腺癌术后患肢淋巴水肿干预效果的meta分析

目的：明确早期渐进性功能锻炼对乳腺癌术后患肢淋巴水肿的干预效果。方法计算机检索PubMed、Web of Science、LISTA、Library of Congress、Acad Search Prem、Cochrane、中国生物医学文献数据库、万方数据库、中国知网数据库和维普数据库。检索时间为2001年1月1日~2015年12月31日。由2名研究者独立筛选文献、评价文献质量和提取数据。采用Revman5.3软件做meta分析。结果共纳入9项随机对照试验研究,按随访1个月、3个月、6个月及以上分组,分别做meta分析。结果显示,干预组患者术后1个月( Z=5.83, P<0.00001)、3个月(Z=3.73,P=0.0002)、6个月及以上(Z=3.10,P=0.002)患肢淋巴水肿发生率均低于对照组,差异有统计学意义( P<0.05)。结论早期渐进性功能锻炼能够有效改善乳腺癌术后患肢淋巴水肿,并具有较好的长期效果。     

飞机旅行与乳腺癌术后淋巴水肿关联性的Meta分析

[目的]系统评价飞机旅行对于乳腺癌术后淋巴水肿的影响。[方法]系统检索MedLine、EMbase、CINAHL、the Cochrane Library数据库中关于飞机旅行与乳腺癌术后淋巴水肿关联性的研究,检索时限为建库至2018年5月31日。采用R 3. 3. 2语言软件对数据进行分析。[结果]共纳入7项研究,Meta分析结果显示:乘坐飞机旅行病人淋巴水肿发生率与未乘坐飞机旅行病人差异无统计学意义[OR=1. 19,95%CI(0. 97,1. 45),P=0. 091 9]。[结论]现有证据表明:飞机旅行与乳腺癌术后淋巴水肿发生无明显关联。     

正念疗法对乳腺癌病人睡眠质量影响的系统评价

[目的]系统评价正念疗法在癌症病人中应用的效果。[方法]计算机检索Medline、Cochrane Library、CINAHL、PubMed、Web of science、CBM、中国知网、维普和万方数据库中有关正念疗法对癌症病人研究的随机对照试验(RCTs)。此外,采用百度、谷歌学术等搜索引擎查找有关文献,并追查已纳入文献的参考文献,以获取未检索到的文献,检索截至2018年6月。2位评价员按纳入与排除标准独立筛选文献,提取资料并进行质量评价后,如有歧义与第3人进行协商。[结果]据纳入原始研究设计的类型,共纳入6个随机对照试验,合计有818例病人。[结论]现有证据表明,正念减压疗法能够改善乳腺癌病人睡眠,但仍需大样本、高质量的RCTs进行验证。     

上肢运动操改善乳腺癌淋巴水肿患者上肢功能的效果观察

目的探讨上肢运动操改善乳腺癌术后淋巴水肿患者上肢功能的效果。方法选取52例乳腺癌术后淋巴水肿行压迫治疗的患者,采用自编的上肢运动操指导患者进行上肢锻炼,运动操包括手指、肘部及肩关节的运动以及联合器具的锻练,在锻炼的同时绑定胸式呼吸训练。比较干预前后患者上肢功能和淋巴水肿的程度。结果干预后上肢功能评定得分下降(t=3.771,P0.001);干预后1例重度水肿减轻至中度,9例中度水肿减轻至轻度。结论运用上肢运动操,可能改善乳腺癌术后淋巴水肿患者行压迫治疗期间的上肢功能,并利于水肿缓解。     

乳腺癌术后上肢淋巴水肿预防策略的证据总结

目的 检索乳腺癌术后上肢淋巴水肿预防方法的相关证据,并评价总结出最佳证据,为医护人员临床决策提供依据。方法 应用PIPOST模式确定循证问题,并构建合适的检索策略和纳排标准,使用计算机检索PubMed、Embase、Cochrane Library、NBOCC、CINAHL、JBI图书馆、NICE指南网、维普、中国知网、万方、CBM数据库中所有关于乳腺癌术后上肢淋巴水肿预防策略的证据。由2名经过循证培训的人员对纳入的文献进行质量评价并且对符合标准的文献进行证据提取。结果 共纳入24篇文献,其中指南4篇,证据总结3篇,系统评价8篇,RCT8篇、类实验1篇。最终总结出锻炼方法、皮肤保护、航空旅行、控制体质量、物理疗法、自我监测、日常生活注意事项共7个方面,48条关于乳腺癌术后预防上肢淋巴水肿策略的最佳证据。结论 乳腺癌术后患者需注重上肢淋巴水肿的预防,临床医护人员可依据乳腺癌术后上肢淋巴水肿预防策略的最佳证据,对患者进行规范的健康教育,降低患者的淋巴水肿发生率。     

音乐疗法对初产妇焦虑和产程进展影响的Meta分析

目的:系统分析音乐疗法对产妇的治疗效果,观察音乐疗法在分娩中的作用,为分娩提供科学依据。方法:通过检索中国知网(CNKI)、万方、维普全文数据库,检索已发表的音乐疗法与分娩的随机对照试验(RCTs)研究,检索期从数据库建库到2018年11月。采用RevMan 5.3软件对纳入研究文献进行Meta分析。结果:纳入15项随机对照试验研究,Meta分析显示:两组产妇焦虑、第一产程、第二产程、剖宫产率比较差异有统计学意义。结论:在常规护理基础上给予音乐疗法可减轻初产妇焦虑,促进产程进展,降低剖宫产率。     

乳腺癌术后患者淋巴水肿真实体验质性研究的系统评价

目的系统评价及整合乳腺癌术后患者淋巴水肿真实体验的质性研究的结果,为乳腺癌患者术后预防淋巴水肿提供参考依据。方法计算机检索PubMed、Cochrane图书馆、Web of Science、Science Direct、Embase、中国期刊全文数据库(Chinese National Knowledge Infrastructure,CNKI)、万方数据库、维普期刊资源整合服务平台、中国生物医学数库(Chinese Biomedical Literature Database,CBM)等国内外数据库,建库以来至2018年3月相关的质性研究文献。参照澳大利亚JBI循证卫生保健中心质性研究质量评价标准,采用Meta整合的方法对研究结果进行整合。结果共纳入9篇文献,提炼出35个研究结果,形成10个新的类属,得到3个整合的结果:淋巴水肿带来的改变;信息的缺乏;生活的希望。结论淋巴水肿严重影响了乳腺癌术后患者的生理、心理及社会功能,患者控制不良情绪、自我管理疾病的意识有待增强,社会支持系统亟需完善,医护人员应及时有效地给患者赋能,促进患者的身心健康。     

Effects of Kinesio Taping on breast cancer-related lymphedema: A meta-analysis in clinical trials

Background: Lymphedema is known as a secondary complication of breast cancer treatment, caused by reduction on lymphatic flow and lymph accumulation on interstitial space. The Kinesio Taping (KT) has become an alternative treatment for lymphedema volume reduction. The objective of the study was to evaluate the literature through a systematic review on KT effects on lymphedema related to breast cancer.

Methods: Search strategies were performed by the following keywords: “Kinesio Taping,” “Athletic Tape,” “Cancer,” “Neoplasm,” “Lymphedema,” and “Mastectomy” with derivations and different combinations. The following databases were accessed: SCIELO, LILACS, MEDLINE via PubMed, and PEDro, between 2009 and 2016. Studies published in English, Portuguese, and Spanish were considered for inclusion. The studies’ methodological quality was assessed by the PEDro scale.

Results: Seven studies were identified by the search strategy and eligibility. All of them showed positive effect in reducing lymphedema (perimeter or volume) before versus after treatment. However, with no effects comparing the KT versus control group or others treatments (standardized mean difference = 0.04, confidence interval 95%: ?0.24; 0.33), the average score of the PEDro scale was 4.71 points.

Conclusions: KT was effective on postmastectomy lymphedema related to breast cancer; however, it is not more efficient than other treatments.     

What is the effect of treating secondary lymphedema after breast cancer with complete decongestive physiotherapy when the bandage is replaced with Kinesio Textape? – A pilot study

Purpose: Secondary lymphedema (SL) following breast cancer is a well-known complication following surgery or radiation. SL may result in loss of functional ability, cosmetic deformities, physical discomfort, recurrent episodes of erysipelas, and psychological distress. There is no evidence as to what is the most effective treatment for SL. Methods: This randomized controlled pilot study included 10 patients treated for SL following breast cancer. The patients were included and screened for SL by a physiotherapist. They were randomized to treatment with CDP with Kinesio Textape or bandage for 4 weeks. Endpoints were quality of life, circumference of the arm, costs, and working environment for the physiotherapist. Results: The two groups were comparable according to baseline data. Outcomes on quality of life, costs, and working environment for the physiotherapist; the treatment with CDP with tape was superior to the CDP with bandage treatment. In regard to reducing the circumference there was no difference. Conclusions: This randomized controlled pilot study shows that CDP with tape can be an alternative to CDP with bandage. The quality of life is higher, the economy and working environment is better, and the effect measured by circumference is comparable. More RCTs are required to increase the evidence for CDP with tape. Implications: Treating lymphedema with CDP with tape after breast cancer is a good alternative to CDP with bandage and makes it possible to treat more patients with less resources.     

乳腺癌患者治疗后并发上肢淋巴水肿的质性研究

目的了解乳腺癌患者术后发生上肢淋巴水肿的体验。方法 2010年4—10月,我们采用质性研究中现象学研究的方法,对10例乳腺癌患者术后上肢淋巴水肿进行深度半结构式访谈,对采集资料进行类属分析。结果淋巴水肿患者的主要体验:①对淋巴水肿认识不够;②对患肢保护重视不够;③生活质量下降;④渴望淋巴水肿的治疗康复信息;⑤随着淋巴水肿病程的延长逐渐失去康复信心;⑥自我应对,减轻症状。结论乳腺癌患者术后上肢淋巴水肿的状况不容乐观,护理人员应深入了解乳腺癌患者治疗后患淋巴水肿的内心感受,在术后及时提供预防淋巴水肿的指导原则,让患者了解淋巴水肿发生后的痛苦体验,使其重视预防,避免淋巴水肿的发生与发展。     

等速肌力训练对乳腺癌术后淋巴水肿的疗效观察

目的:探讨肩关节内收等速肌力训练对乳腺癌术后淋巴水肿的影响。方法:乳腺癌术后并发上肢水肿患者68例,随机分为等速组和对照组,每组各34例。2组均给予常规康复训练,等速组在此基础上进行肩关节内收等速肌力训练。训练前后采用放射性核素淋巴扫描观测2组患侧上肢淋巴流量的变化;在腕横纹上10cm处测量2组双侧上臂周径;应用等速肌力测试系统为等速组记录等速肌力测定值。结果:治疗2个月后,2组患者上肢淋巴流量均较组内治疗前增加(P<0.05),双侧上臂周径差值均较组内治疗前减小(P<0.05),与对照组治疗后比较,等速组上肢淋巴流量较大(P<0.05),双侧上臂周径差值较小(P<0.05)。治疗后,等速组患者等速肌力测量值(峰力矩、总功率、平均功率)均较治疗前明显增加(P<0.05)。结论:肩关节内收等速肌力训练可以增加乳腺癌术后患侧上肢淋巴回流量,有效减少淋巴水肿。     

The effect of adjuvant radiotherapy on skin biophysical properties in patients with breast cancer at risk for breast lymphedema: A prospective study

Breast cancer (BC) is the most common type of cancer among women. Radiotherapy (RT) is one of the main and primary treatment options for BC, especially in breast-conserving surgery (BCS). BC patients who underwent RT experience a wide range of symptoms, in which breast oedema and irritation of the skin take the lion's share. Breast oedema/lymphedema, which is also a prominent side effect after RT should be well determined in earlier settings due to the chronicity of lymphedema. Therefore, this study aimed to analyze the biophysical parameters of skin on the ipsilateral (IL) and contralateral (CL) sites via Tissue dielectric constant (TDC) and Transepidermal water loss (TEWL) methods in terms of oedema and skin barrier function (SBF). The following reference points before and after the RT were measured: (R1: Pectoralis muscle, R2: Upper breast, R3: Lower breast, R4: Lateral site of the thorax). A total of 24 BC patients (mean age and BMI: 52.78 ± 9.85 years and 28.42 ± 5.64 kg/m²) were evaluated. In the IL site, the SBF was not found significant in R1-R3, whereas significantly lower SBF was observed in R4 after RT (t = −3.361, p = 0.003). A significant increase in TDC was observed in R2 at the 5.0 mm depth (t = −2.500, p = 0.02). We suggest that a longer period of follow-up should be carefully carried out to track changes in terms of SBF and oedema in the irradiated breast. The increased need for early detection of changes associated with breast lymphedema can be achievable via noninvasive, safe, cheap, and easily repeatable devices.     

Physiological characteristics of the body fluid in lymphedematous patients postbreast cancer surgery, focusing on the intracellular/extracellular fluid ratio of the upper limb

Aim:  The aim of this research was to determine the physiological characteristics of patients with lymphedema following breast cancer surgery, based on differences between the quantity of body water in the right and left fingertips, with a view to establishing whether or not this simple measurement could serve as a predictive index for the onset of lymphedema.
Method:  The research was conducted at a hospital in Hiroshima, Japan (August 2004 to December 2004). Observations were made on 39 female breast cancer patients who had undergone surgery and 45 healthy female participants. Additional information was collected via interviews with the individual participants. The quantity of body water in all the participants was measured by using a bioimpedance spectrum analysis system. Comparisons of the intracellular/extracellular fluid ratios (I/Es) were made between the edema patients and the non-edema patients, with further testing being done between the affected and unaffected sides of the upper limb in the edema patients.
Results:  In the edema patients, significant differences were recognized between the affected side's upper limb I/E and the unaffected side's upper limb I/E. In relation to the affected side's upper limb I/E of the edema patients, even when the mean value and standard deviation were included, the value did not exceed 1.0 and the mean – 3 SD value of the affected side's upper limb I/E in the non-edema patients was 1.04.
Conclusions:  The results suggest that measurements of the affected and unaffected sides' upper limb I/E showed a potential for use as a reliable predictive index for lymphedema.     

新辅助化疗对可手术乳腺癌保乳手术影响的系统评价

目的系统评价新辅助化疗对可手术乳腺癌保乳手术疗效和手术实施的影响。方法电子检索Cochrane图书馆（2007年第1期）、CENTRAL（1970～2007．3）、PubMed（1978～2007，3）、CBM（1978～2006）、CNKI（1994～2007）、CMCC（1994～2007．5）。网上检索查阅ASCO（1997～2007）、St．Gallen2005、NCCN2007；手工检索四川I大学医学图书馆内相关馆藏杂志，搜集新辅助化疗（NAC）＋乳房切除术／保乳手术VS乳房切除术／保乳手术＋术后化疗的随机对照试验（RCT）。研究对象限于T1-3N0-2M0期患者且手术前后共接受至少4个疗程（术前至少2个疗程）的化疗，按照Cochrane协作网的方法评价纳入研究质量和提取有效数据进行Meta分析。结果共纳入3个RCT包括2931例患者，平均随访17～137个月。3个RCT质量均较高。Meta分析结果显示，NAC不影响可手术乳腺癌患者的9年总生存率[RR=0．99，95％CI（O．91，1．07）]和无瘤生存期[RR=I．04，95％CI（O．94，1．15）]，不会显著增加可手术乳腺癌患者保乳手术后同侧乳腺肿瘤复发率[RR=I．34，95％CI（o．84，2．13）]。2个RCT结果显示，NAC可提高可手术乳腺癌的保乳手术率，但另一个小样本RCT不支持这一结论。1个RCT结果显示，NAC不会影响血清肿、出血、伤口感染等手术相关并发症的发生率。3个RCT均无单独关于保乳手术患者的生存率、无瘤生存期、术中组织切除量、重复切除率、手术时间、以及对局部美容效果影响的数据。结论NAC不影响可手术乳腺癌总9年生存率和无瘤生存期，不能提高保乳患者的同侧乳腺肿瘤复发率，但可能提高可手术乳腺癌的保乳手术率。对初始就能保乳的较小乳腺癌，NAC对其生存率、保乳率的影响还不明确。还需要开展大样本的RCT明确NAC对可手术乳腺癌保乳率、保乳术中重切率、组织切除量、手术时间、手术费用等的影响。     

Lymphedema in gynecologic cancer survivors: an area for exploration?

There is a paucity of research on the incidence and impact of lower body lymphedema in the gynecologic cancer population. The cornerstone of management for gynecologic cancer is cytoreductive surgery. Depending on the site of the cancer, surgery traditionally involves removal of the ovaries, fallopian tubes, uterus and cervix, accompanied with extensive node dissection throughout the pelvic cavity, and, in the case of ovarian cancer, removal of the omentum. Resection of pelvic lymph nodes and vessels, compounded by gravitational influences on lymphatic flow, can lead to lymphatic congestion that impairs mobility, raises intra-abdominal pressure, and increases abdominal and extremity girth. Lymphedema can be an indicator of recurrence and is frequently associated with toxicities such as skin breakdown, pain, neuropathy, and myopathy. Physical changes, role changes, and psychosocial issues are common symptoms reported by breast cancer survivors with lymphedema. Assessment and management strategies for upper extremity lymphedema following treatment of breast cancer cannot be directly transferred to lower extremity lymphedema affecting women with cancer of the ovary, cervix, uterus, and vulva because of limb size, volume, and location. Clinicians have anecdotally reported the presence of lower body lymphedema in many gynecologic cancer patients. Survivors have described tightness, swelling, and heaviness. Despite these clinical findings, no systematic study of lower body lymphedema in women with gynecologic cancer has been conducted. Whether lower body lymphedema is as debilitating and long-term as post-mastectomy lymphedema is not empirically known.     

Physical therapy intervention following surgical treatment of carpal tunnel syndrome in an individual with a history of postmastectomy lymphedema

BACKGROUND AND PURPOSE: This case report describes the physical therapy examination, intervention, and outcomes for a patient with lymphedema following breast cancer treatment who underwent carpal tunnel release. CASE DESCRIPTION: The patient was a 53-year-old woman with right upper-limb lymphedema and symptoms of carpal tunnel syndrome (CTS) in her right hand who underwent a carpal tunnel release. Management of her lymphedema included the use of general anesthesia with reduced tourniquet time in conjunction with physical therapy, which included use of compression bandaging, limb positioning, and exercise. OUTCOMES: Following surgical release, the patient's numbness and pain were alleviated. Right-hand grip strength increased following active exercise. Girth of the forearm decreased 1 to 1.5 cm at the 2 most distal measurement sites, and girth of the arm increased 1.5 to 2 cm 6 months after surgery. DISCUSSION: This case supports the option of elective hand surgery for CTS in an individual with chronic lymphedema.