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。

Manual Lymph Drainage for the Treatment of Upper Limb Lymphedema after Breast Cancer Treatment

Objective To explore the effectiveness of manual lymph drainage （MLD） in the treatment of breast-cancer-related lymphedema. Methods From 2008 to 2012, 101 patients with unilateral arm lymphedema after mastectomy were enrolled and divided into three groups based on the circumferential difference （d） between lymphedematous and contralateral limbs prior to MLD：group A （d〈1-2 cm）, group B （5 cm≥d≥2 cm）, group C （d〉5 cm）. After 1 course （15 days） of complex decongestive therapy （CDT）：MLD＋low elastic bandage, changes of limb circumference and tissue edema were measured and the differences between edema and non-edema arms after treatment were compared to evaluate edema reduction. Subjective feelings of each patient were recorded. Tissue edema were measured with multiple-frequency bioelectrical impedance analysis. Results After CDT treatment, significant reduction in circumference of the edematous limbs （ P〈0.01） and edema fluid in tissue （P〈0.01） were observed. Comparison of the reduction of excess tissue edema and limb circumference among 3 groups showed： group C〉group B〉group A （P〈0.01）. All patients were satisfied with the treatment. Conclusion Complex decongestive therapy is effective in treating lymphedema and improving physical appearance of the limb. The patients with more initial circumferential difference get better results in MLD.