ObjectiveTo explore the effects of seven-step complex decongestion therapy (CDT) on post-operative upper limb lymphedema of breast cancer. MethodsFrom August, 2015 to September, 2016, 71 patients with upper limb lymphedema after breast cancer surgery accepted CDT for 20 days, including skin care, opening of lymphatic pathway, relief of scar tissue, manual lymphatic drainage, bandage compression, air pressure wave therapy and functional exercise. The circumference of eight sites of both limbs was measured and the differences were calculated before treatment, and one, five, ten, fifteen and twenty days of the treatment. ResultsThe differences of circumference increased one to 15 days of the treatment (Z>2.03, P<0.05), and decreased 20 days of the treatment (Z=3.01, P<0.01). ConclusionCDT is effective on lymphedema after breast cancer surgery for 20 days of a course, but may worsen in the first 15 days, which may be related to acute stress response or redistribution of lymph.
ZHANG Hui-ting
,
ZHONG Qiao-ling
,
ZHANG Hui-zhen
,
LIU Lin-fei
,
LIU Li-li
,
ZHANG Li-juan
,
TANG Hai-lin
. Effects of Seven-step Complex Decongestion Therapy on Upper Limb Lymphedema after Operation for Breast Cancer[J]. Chinese Journal of Rehabilitation Theory and Practice, 2017
, 23(9)
: 1015
-1020
.
DOI: 10.3969/j.issn.1006-9771.2017.09.006
[1] Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012 [J]. CA Cancer J Clin, 2015, 65(2): 87-108.
[2] 黄哲宙,陈万青,吴春晓,等. 中国女性乳腺癌的发病和死亡现况——全国32个肿瘤登记点2003-2007年资料分析报告[J]. 肿瘤, 2012, 32(6): 435-439.
[3] Petrek JA, Heelan MC. Incidence of breast carcinoma-related lymphedema [J]. Cancer, 1998, 83(12 Suppl): 2776-2781.
[4] Petrek JA, Senie RT, Peters M, et al. Lymphedema in a cohort of breast carcinoma survivors 20 years after diagnosis [J]. Cancer, 2001, 92(6): 1368-1377.
[5] Hayes SC, Janda M, Cornish B, et al. Lymphedema after breast cancer: incidence, risk factors, and effect on upper body function [J]. J Clin Oncol, 2008, 26(21): 3536-3542.
[6] Quirion E. Recognizing and treating upper extremity lymphedema in postmastectomy/lumpectomy patients: a guide for primary care providers [J]. J Am Acad Nurse Pract, 2010, 22(9): 450-459.
[7] Leal NF, Carrara HH, Vieira KF, et al. Physiotherapy treatments for breast cancer-related lymphedema: a literature review [J]. Rev Lat Am Enfermagem, 2009, 17(5): 730-736.
[8] Szuba A, Cooke JP, Yousuf S, et al. Decongestive lymphatic therapy for patients with cancer-related or primary lymphedema [J]. Am J Med, 2000, 109(4): 296-300.
[9] Mayrovitz HN. The standard of care for lymphedema: current concepts and physiological considerations [J]. Lymphat Res Biol, 2009, 7(2): 101-108.
[10] 张丽娟,黄中英,朱晓丽,等. 徒手淋巴引流预防乳腺癌术后上肢淋巴水肿的效果[J]. 实用医学杂志, 2015, 31(17): 2910-2913.
[11] Zhang L, Fan A, Yan J, et al. Combining manual lymph drainage with physical exercise after modified radical mastectomy effectively prevents upper limb lymphedema [J]. Lymphat Res Biol, 2016, 14(2): 104-108.
[12] 辛明珠,张惠婷,刘凤,等. 多磺酸粘多糖乳膏用于乳腺癌术后腋网综合征的疗效观察[J]. 护理学杂志, 2016, 31(20): 32-34.
[13] Cho Y, Do J, Jung S, et al. Effects of a physical therapy program combined with manual lymphatic drainage on shoulder function, quality of life, lymphedema incidence, and pain in breast cancer patients with axillary web syndrome following axillary dissection [J]. Support Care Cancer, 2016, 24(5): 2047-2057.
[14] 唐磊. 淋巴水肿治疗仪在乳腺癌术后患肢淋巴水肿治疗中的应用[J]. 中华护理杂志, 2006, 41(9): 841.
[15] National Lymphedema Network. 18 steps to Prevention for Upper Extremities [EB/OL]. (2003-08-18). [2016-07-07]. http//www/Lymphnet.Org/prevention.
[16] Olszewski WL, Jain P, Ambujam G, et al. Topography of accu mulation of stagnant lymph and tissue fluid in soft tissues of human lymphedematous lower limbs [J]. Lymphat Res Biol, 2009, 7(4): 239-245.
[17] 马宁,孙向红. 多层无弹性绷带在晚期乳腺癌合并上肢淋巴水肿患者中应用的效果观察[J]. 现代医学, 2016, 44(6): 876-879.
[18] 陈佳佳,汪立,于子优,等. 手法淋巴引流治疗乳腺癌术后上肢淋巴水肿[J]. 组织工程与重建外科杂志, 2015, 11(5): 310-312.
[19] 严梅,蒋妮,王雪芹,等. 复合护理干预在乳腺癌术后淋巴水肿治疗效果的研究[J]. 护士进修杂志, 2011, 26(12): 1109-1112.
[20] Vojácková N, Sebková M, Schmiedbergerová R, et al. [Cohort of lymphedema patients followed at the Lymphology Centre of the Dermatovenerologcal Clinic of the 2nd Faculty of Medicine University Hospital Na Bulovce Prague in years 2000 to 2005. A retrospective study] [J]. [in Czech]. Cas Lek Cesk, 2007, 146(1): 57-61, 61-62.
[21] Koul R, Dufan T, Russell C, et al. Efficacy of complete decongestive therapy and manual lymphatic drainage on treatment-related lymphedema in breast cancer [J]. Int J Radiat Oncol Biol Phys, 2007, 67(3): 841-846.
[22] Randheer S, Kadambari D, Srinivasan K, et al. Comprehensive decongestive therapy in postmastectomy lymphedema: an Indian perspective [J]. Indian J Cancer, 2011, 48(4): 397-402.
[23] 汪立,陈佳佳,于子优,等. 手法淋巴引流综合消肿疗法治疗盆腔恶性肿瘤根治术后下肢淋巴水肿[J]. 组织工程与重建外科杂志, 2016, 12(3): 186-188.
[24] 刘宁飞,汪立,陈佳佳,等. 手法淋巴引流综合治疗肢体慢性淋巴水肿[J]. 中华整形外科杂志, 2010, 26(5): 337-339.
[25] 王建枝,殷莲华. 病理生理学[M]. 8版. 北京:人民卫生出版社, 2013: 131-136.