手法淋巴引流治疗乳腺癌术后上肢淋巴水肿

目的 探讨运用手法淋巴引流(Manual Lymph Drainage,MLD)治疗乳腺癌术后上肢淋巴水肿的疗效。方法2008年至2012年,101例乳腺癌术后上肢淋巴水肿患者按治疗前患肢与健肢的周径(d)差值分3组:A组(d5 cm)。3组患者均进行1个疗程(15 d)的淋巴水肿综合消肿治疗(Complex Decongestive Therapy,CDT):手法淋巴引流+低弹性绷带包扎。通过检测引流前后健患侧的组织水分和肢体周径,计算水分比率与周径比率,同时调查患者对手法引流及绷带使用情况的主观感受,以观察并评价患者对治疗的适应性和接受度。组织水分采用多频生物电阻人体成分分析仪进行检测。结果 101例患者经CDT治疗后,患肢组织水分和肢体周径均呈显著下降(PB组>A组(P<0.01),即治疗效果与水肿严重程度成正比。几乎所有患者对治疗方法及效果表示满意。结论 CDT能有效促进乳腺癌术后上肢淋巴水肿的淋巴回流,减轻患肢水肿,改善患肢外形,帮助功能恢复,并且该治疗对水肿程度较重的患者疗效尤其显著。     

手法淋巴引流护理缓解乳腺癌患者术后淋巴水肿与腋网综合征的效果分析

目的 分析手法淋巴引流护理缓解乳腺癌术后淋巴水肿与腋网综合征的干预效果。方法 选取湛江市妇幼保健计划生育服务中心2018年1月至2020年1月收治乳腺癌术后并发淋巴水肿与腋网综合征患者50例,按随机双盲法分为两组,对照组25例,常规护理;观察组25例,基于对照组采用手法淋巴引流护理;比较两组患者干预效果及症状缓解情况。结果 观察组患者干预3个月、6个月、12个月的有效率分别为72.0%、80.0%、100.0%,均高于对照组的44.0%、56.0%、72.00%,差异有显著性(P <0.05)。观察组患者干预3个月、6个月、12个月的周径差值减少幅度高于对照组,干预后1个月、3个月、6个月、12个月时的患肢肩关节外展角度高于对照组,术后患肢紧绷感、条索结构、患肢麻木、患肢疼痛消失时间短于对照组(P <0.05)。观察组患者干预1个月后日常社会功能、上肢活动功能、上肢症状评分低于对照组(P <0.05)。结论 手法淋巴引流护理可缓解乳腺癌术后淋巴水肿与腋网综合征临床症状,增加患肢活动范围,干预效果好。     

乳腺癌手术后的淋巴水肿

重点介绍了乳腺癌手术后淋巴水肿的病因、病理生理以助于预防和减少其发生。     

应用远红外线(FIR)治疗乳腺癌相关的淋巴水肿的肿瘤安全性研究

目的 探讨应用远红外线(FIR)治疗乳腺癌相关的淋巴水肿的肿瘤安全性.方法 选取乳腺癌切除术后5年以上,且伴有1年以上上肢淋巴水肿的患者,分为FIR组和对照组,分别采用FIR治疗和绷带加压保守治疗.观察指标包括肿瘤标志物(CA153、CA125)、相关结构的超声检查,并对治疗后1年的不良反应进行监测.通过体外试验观察F...     

乳腺癌手术后的淋巴水肿(编译)

重点介绍了乳腺癌手术后淋巴水肿的病因、病理生理以助于预防和减少其发生。     

乳腺癌相关淋巴水肿的危险因素及治疗进展

乳腺癌是女性最常见的恶性肿瘤,近年来,乳腺癌发病率的增长速度仅次于肺部恶性肿瘤,并且呈现逐渐年轻化的趋势,得益于治疗技术的发展及人们对于乳腺检查的重视、自身健康意识的提高,患者通常能得到及时治疗,但如何避免或治疗乳腺癌相关并发症仍未得到足够重视.淋巴水肿是乳腺癌治疗后最常见的并发症,一旦出现则很难治愈,会长期影响患者的...     

早期徒手淋巴引流联合压力袖套预防乳腺癌相关淋巴水肿的效果

目的:观察乳腺癌改良根治术后实施早期干预措施降低乳腺癌相关淋巴水肿(BCRL)发生率、减轻相关症状、提高患者生命质量的效果。方法:纳入2021年12月至2022年8月符合条件的乳腺癌患者114例,随机分为3组,对照组实施常规护理,干预1组在对照组的基础上实施术后早期徒手淋巴引流(MLD),干预2组在干预1组的基础上增加压力袖套的使用。对比分析术后1个月、3个月BCRL发生率,术后3个月BCRL相关症状及生命质量,以评价干预效果。结果:术后1个月,3组BCRL发生率差异无统计学意义(P>0.05)。术后3个月,对照组BCRL发生率高于其他两组(P<0.05);对照组BCRL相关症状得分高于干预1组,干预1组高于干预2组,差异有统计学意义(P<0.001);对照组生命质量总分低于干预1组,干预1组低于干预2组,差异有统计学意义(P<0.05)。结论:乳腺癌术后早期进行徒手淋巴引流联合压力袖套干预可有效降低术后乳腺癌相关BCRL发生率,提高患者生命质量。     

照护者参与乳腺癌相关淋巴水肿患者自我护理研究进展

综述乳腺癌术后淋巴水肿照护者参与自我护理的现状及影响因素,为制订针对性干预方案提供参考。提出可从照护者的负性情绪、健康素养以及家庭复原力等方面进行干预,以促进家庭照护者积极参与患者术后自我护理,缓解或消除患者乳腺癌相关淋巴水肿,改善生活质量。     

患者报告结局在乳腺癌相关淋巴水肿的应用研究进展

从乳腺癌相关淋巴水肿患者报告结局内容、测量工具和应用效果三方面进行阐述,介绍关于乳腺癌相关淋巴水肿患者报告结局测量工具的不同特性及应用特点,分析在不同研究目的中工具的选择,提出患者报告结局在淋巴水肿中的应用方法,为我国乳腺癌相关淋巴水肿患者报告结局评估工具的开发及症状管理、临床决策的实施提供参考。     

毫米波治疗乳腺癌术后上肢淋巴水肿患者的护理

对46例乳腺癌术后上肢水肿患者用毫米波(频率36 GHz,输出功率120 mW)治疗.结果 治疗2个疗程后患者主观症状如上肢沉重感、烧灼感及肢体活动度有明显的改善,优良29例,良好6例.有效5例,无效6例,治疗总有效率87.0%(40/46).随访6个月,无1例加重.提示毫米波治疗乳腺癌术后轻、中度上肢淋巴水肿简便有效,治疗期间做好患者的心理护理、患侧上肢水肿的护理,合理选择照射方位、频率、功率、时间,做好饮食护理及密切观察病情变化,能有效促进淋巴液回流,减轻患肢水肿,从而提高患者的生活质量.     

Time-course of arm lymphedema and potential risk factors for progression of lymphedema after breast conservation treatment for early stage breast cancer

Abstract: The objective of this study was to describe the progression of arm lymphedema (ALE) after the initial presentation among patients receiving breast conservation therapy for early stage breast cancer and to identify potential risk factors contributing to ALE progression. The study sample was the 266 stage I or II breast cancer patients with documented ALE who underwent breast conservation therapy that included lumpectomy, axillary staging followed by radiation therapy. ALE were graded according to a difference of 0.5–2 cm (mild), 2.1–3 cm (moderate), and >3 cm (severe) in the circumference between the upper extremities for the treated and untreated sides. ALE at presentation was scored as mild, moderate, and severe in 109 (41%), 125 (47%), and 32 (12%) patients, respectively. One third of patients with ALE progressed to a more severe grade of lymphedema at 5 years of follow‐up. Age older than 65 years at the time of breast cancer treatment was associated with higher risk of ALE progression when compared 65 year age or younger (p = 0.04). The patients who had regional lymph node irradiation including posterior axillary boost were at higher risk of lymphedema progression than the patients treated with whole breast irradiation only (p = 0.001). Progression of ALE is a common occurrence. The current study provides support for the utility of routine arm measurements after breast cancer treatment to facilitate timely diagnosis and treatment of ALE.     

Breast-cancer related lymphedema: a review of procedure-specific incidence rates, clinical assessment AIDS, treatment paradigms, and risk reduction

With improved outcomes following treatment of breast cancer, chronic toxicities including breast cancer related lymphedema (BCRL), gain increased significance with limited evidence-based guidelines present. This review attempts to summarize data addressing these concerns and provides recommendations based on currently published data. Substantial differences exist in rates of BCRL reported in the literature ranging from less than 5% to 65% based on locoregional therapy. Based on recent data, early diagnosis of BCRL appears critical and requires careful attention to patient risk factors and the use of newer diagnostic tools. Initial treatment with decongestive lymphatic therapy/compressive stockings can provide significant improvement in patient symptoms and volume reduction of edematous extremities. At this time, consensus recommendations for disease classification, diagnostic testing and treatment are still lacking. Awareness of the frequency of this toxicity is now important as more accurate clinical aids have become accessible to diagnose the condition at an earlier stage allowing timely intervention providing the opportunity for treatment strategies to be more effective.     

宫颈癌根治术后下肢淋巴水肿患者自我护理审查指标的制定及障碍因素分析

目的 根据宫颈癌根治术后下肢淋巴水肿自我护理的最佳证据，制定审查指标，并分析障碍因素和促进因素，为促进证据的临床转化提供参考。方法 总结宫颈癌根治术后下肢淋巴水肿自我护理的21条最佳证据，在此基础上确定审查指标、审查方法，并进行障碍和促进因素分析。结果 共制定15条质量审查指标，其中6条审查指标执行率低于60%，障碍因素主要为缺乏规范化管理流程、证据应用配合度不高、健康教育落实不到位、延续护理服务有待提升、自我护理重要性认知不足等。结论 临床科室应用证据时，需要结合促进因素及障碍因素、患者意愿及偏好等有针对性地采取措施，利于最佳证据的临床实践。     

宫颈癌根治术后下肢淋巴水肿患者自我护理审查指标的制定及障碍因素分析

目的 根据宫颈癌根治术后下肢淋巴水肿自我护理的最佳证据,制定审查指标,并分析障碍因素和促进因素,为促进证据的临床转化提供参考。方法 总结宫颈癌根治术后下肢淋巴水肿自我护理的21条最佳证据,在此基础上确定审查指标、审查方法,并进行障碍和促进因素分析。结果 共制定15条质量审查指标,其中6条审查指标执行率低于60%,障碍因素主要为缺乏规范化管理流程、证据应用配合度不高、健康教育落实不到位、延续护理服务有待提升、自我护理重要性认知不足等。结论 临床科室应用证据时,需要结合促进因素及障碍因素、患者意愿及偏好等有针对性地采取措施,利于最佳证据的临床实践。     

Quality assessment of clinical practice guidelines for adaptation in burn injury

Objectives

A number of clinical practice guidelines (CPGs) are available for managing burn injury patients but clinical practice is highly variable. We report the first steps to trans-contextual adaptation of international burn CPGs to local settings.

Methods

Key clinical topics and questions to be covered in the final guideline were defined and prioritized. Systematic search between 1990 and 2008 retrieved 546 citations, of which 24 were CPGs on the general and intensive care of burn patients. Assessment of the clinical content of CPGs was carried out. Methodological quality of CPGs was evaluated using the AGREE instrument.

Results

Of the 24 CPGs evaluated, 10 (42%) were evidence-based. All major burn topics were covered by at least one CPG, but no single CPG addressed all areas important in terms of outcomes. According to the AGREE criteria, 2 CPGs (8%) were strongly recommended, 14 with provisos or alterations (58%) and the rest were not recommended for adaptation.

Conclusions

Although existing CPGs for the management of burn may accurately reflect agreed clinical practice, most performed poorly when evaluated for methodological quality. Future CPG efforts addressing these methodological shortcomings would add substantially to the improved management of burned patients.     

Reducing chronic breast cancer‐related lymphedema utilizing a program of prospective surveillance with bioimpedance spectroscopy

This single‐institution experience evaluated the use of bioimpedance spectroscopy to facilitate early detection and treatment of breast cancer‐related lymphedema (BCRL) in a cohort of 596 patients (79.6% high risk). Seventy‐three patients (12%) developed an elevated L‐Dex score with axillary lymph node dissection (P < .001), taxane chemotherapy (P = .008), and regional nodal irradiation (P < .001) associated. At last follow‐up, only 18 patients (3%) had unresolved clinically significant BCRL requiring complete decongestive physiotherapy. This rate of BCRL is lower than reported in contemporary studies, supporting recent NCCN guidelines promoting prospective screening, education and intervention for BCRL.     

宫颈癌根治术后患者下肢淋巴水肿自我护理的最佳证据总结

目的 检索、评价和汇总宫颈癌根治术后患者下肢淋巴水肿自我护理的最佳证据,为临床护理工作提供参考。方法 按照“6S”金字塔模型系统检索国内外数据库关于宫颈癌根治术后患者下肢淋巴水肿自我护理的证据,包括临床决策、指南、证据汇总、推荐实践、系统评价及专家共识。检索时限从建库至2022年1月。结果 共纳入11篇文献,包括临床决策1篇、指南3篇、系统评价3篇、证据总结1篇、专家共识3篇。证据主要涉及危险因素、自我护理措施、健康教育与随访3个方面,包含10个亚主题共23条证据。结论 临床医护人员应将临床具体情景与循证医学证据相结合,选择有针对性的最佳证据,为下肢淋巴水肿患者提供科学的护理指导,提升患者自我护理能力。     

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。     

Effect of manual lymphatic drainage combined with vacuum sealing drainage on axillary web syndrome caused by breast cancer surgery

The aim of the study was to explore the application value of manual lymphatic drainage combined with vacuum sealing drainage in axillary web syndrome (AWS) after breast cancer surgery. From 1 April 2020 to 1 June 2020, a total of 102 patients with AWS after axillary lymph node biopsy or axillary lymph node dissection in our hospital were included in this prospective study. According to the random number table method, all patients were divided into the study group (n = 51) and the control group (n = 51). The study group received the treatment of manual lymphatic drainage combined with vacuum sealing drainage, and the control group received health education and the treatment of functional training. The efficacy observation indicators included duration time to the disappearance of relevant clinical symptoms, degree of pain, angle of abduction of the affected limb, degree of upper limb disability function and quality of life. The duration time to the disappearance of cord-like nodules and tightness in the study group was both significantly shorter than that in the control group (both P < .05). In the time point of 1 and 3 months after the intervention, compared with that in the control group, the study group had a significantly lighter degree of pain, a better degree of upper limb disability function and higher quality of life (all P < .05). Manual lymphatic drainage combined with vacuum sealing drainage can shorten the disappearance time of relevant clinical symptoms, relieve the degree of pain, improve the upper limb disability function and improve the quality of life in patients with AWS.     

Lymphaticovenular anastomosis improves quality of life and limb volume in patients with secondary lymphedema after breast cancer treatment

Secondary lymphedema is a common side effect of breast cancer treatment, with significant impact on patients' physical and psychological well‐being. Conservative therapies are the gold standard treatment, however surgical options are becoming more popular. Lymphaticovenular anastomosis (LVA) is a supermicrosurgical procedure that aims to restore lymphatic flow by anastomosing damaged lymphatics to subcutaneous venules. We aimed to assess the effects of LVA on patients' limb volume and quality of life. Pre‐ and postoperative limb volumes and LYMQOL scores were collected for patients undergoing LVA for lymphedema secondary to breast cancer. Thirty‐seven patients underwent LVA. A significant reduction was seen in median excess limb volume postoperatively (13.3%‐6.6%, P < 0.005), with volumetric improvement seen in 78% of patients. Thirteen patients were able to discontinue compression garment use. Eighty‐six percent of patients reported improved quality of life postoperatively with median LYMQOL score increasing from 90 to 104 points (P < 0.005). LVA is a minimally invasive surgical option for patients with early stage lymphedema. It can lead to significant volumetric improvements and in select patients, freedom from compression therapy. LVA can also lead to significant improvements in quality of life, in particular patients' mood and perception of their appearance.