地奥司明联合氢氯噻嗪治疗乳腺癌术后上肢淋巴水肿的效果

目的 探讨地奥司明联合氢氯噻嗪治疗乳腺癌术后上肢淋巴水肿的临床疗效。方法 选择2017年1月—2018年12月在德阳市人民医院诊治的乳腺癌术后上肢淋巴水肿患者172例作为研究对象，依据不同的治疗方法将患者分为对照组（72例）和观察组（100例）。对照组口服氢氯噻嗪片，50 mg/次，2次/d。观察组在对照组治疗的基础上口服地奥司明片，0.9 g/次，2次/d。2周为1疗程，两组患者均进行2个疗程的观察治疗。观察两组患者的临床疗效，同时比较两组的淋巴水肿与乳腺癌问卷（LBCQ）评分、手臂5点周径、肩关节活动优良率。结果 治疗后，观察组与对照组的治疗总有效率分别为95.0%和70.8%，两组比较差异具有统计学意义（P<0.05）。治疗后，两组的LBCQ评分均显著低于治疗前（P<0.05），且观察组评分也显著低于对照组（P<0.05）。观察组治疗前后患侧上肢5点周径对比差异都无统计学意义，对照组治疗后虎口掌径与腕横纹周径显著增加（P<0.05）。治疗后，观察组的肩关节活动优良率为99.0%，显著高于对照组的88.9%（P<0.05）。结论 地奥司明联合氢氯噻嗪治疗乳腺癌术后上肢淋巴水肿不会改变患侧上肢5点周径，可促进缓解临床症状，改善肩关节功能，从而提高治疗效果。

Effects of diosmin combined with hydrochlorothiazide on upper limb lymphedema after breast cancer surgery

Objective To investigate the effects of diosmin combined with hydrochlorothiazide in treatment of upper limb lymphedema after breast cancer surgery. Methods Patients (172 cases) with upper limb lymphedema after breast cancer surgery from January 2017 to December 2018 in People''s Hospital of Deyang City were selected. And patients were divided into control group (72 cases) and observation group (100 cases), accorded to different treatment methods. Patients in the control group were po administered with Hydrochlorothiazide Tablets, 50 mg/time, twice daily. Patients in the observation group were po administered with Diosmin Tablets on the basis of control group, 0.9 g/time, twice daily. 2 weeks was a course of treatment, and patients in two groups were treated for 2 courses. The clinical efficacy in two groups were observed, and LBCQ score, 5 point peri-diameter of upper limb, and excellent and good rate of shoulder joint movement were compared. Results After treatment, the total effective rates in the observation group and the control group were 95.0% and 70.8%, respectively, with statistically significant differences between two groups (P<0.05). After treatment, the LBCQ score in two groups was significantly decreased (P<0.05), and the score in the observation group was significantly lower than that in the control group (P<0.05). In the observation group, there was no statistically significant difference in the 5 point peri-diameter of upper limb of the affected side before and after treatment. After treatment, the diameter of palm width and the circumferential diameter of the wrist in the control group were significantly increased (P<0.05). After treatment, the excellent and good rate of shoulder joint movement in the observation group was 99.0%, which was significantly higher than 88.9% in the control group (P<0.05). Conclusion Diosmin combined with hydrochlorothiazide in treatment of upper limb lymphedema after breast cancer surgery will not change the 5-point circumference diameter of the affected side of upper limb, which can relief the clinical symptoms, improve the shoulder joint function, and thus improve the treatment effect.