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护理学报 ›› 2019, Vol. 26 ›› Issue (12): 51-56.doi: 10.16460/j.issn1008-9969.2019.12.051

• 循证护理 • 上一篇    下一篇

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

李文姬1a, 李晓瑾1a,2, 周春兰1b,2   

  1. 1.南方医科大学南方医院 a.乳腺科;b.护理部,广东 广州 510515;
    2.南方医院JBI循证护理合作中心,广东 广州 510515
  • 收稿日期:2019-03-20 发布日期:2020-07-08
  • 通讯作者: 李晓瑾（1989-）,女,河南巩义人,硕士研究生,主管护师,E-mail: xiaojinli1989@163.com。
  • 作者简介:李文姬（1979-）,女,江苏句容人,本科学历,副主任护师,护士长。
  • 基金资助:
    南方医院循证项目（2017EBNd003）

Effectiveness of Complex Decongestive Therapy in Lymphedema of Postoperative Breast Cancer Patients: A Systematic Review

LI Wen-ji1a, LI Xiao-jin1a,2, ZHOU Chun-lan1b,2   

  1. 1a. Dept. of Breast Surgery; 1b. Dept. of Nursing Administration, Nanfang Hospital, Southern Medical University,Guangzhou 510515, China;
    2. PR China Nanfang Nursing Centre for Evidence-Based Practice: A Joanna Briggs Institute Affiliated Group, Guangzhou 510515, China
  • Received:2019-03-20 Published:2020-07-08

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摘要： 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）,P<0.001]。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。

关键词: 乳腺癌, 淋巴水肿, 综合消肿疗法, 系统评价

Abstract: Objective To assess the effect of complex decongestive therapy (CDT) on excess arm volume or patient-centered outcomes in postoperative breast cancer patients with lymphedema. Methods We searched Cochrane Library, PubMed, EMBASE, Web of Science, CINAHL, weipu database (VIP), Chinese journal full-text database (CNKI), Wanfang database and clinical research database (www.clinicaltrials.gov) to gather all studies. Two researchers independently searched, scanned to identify eligible studies. Studies were critically appraised using quasi-experimental study appraisal instruments from the Joanna Briggs Institute. Data were extracted and analyzed by using RevMan5.2 software for meta-analysis. Results Eleven studies were included, all of which were quasi-experimental studies, with 871 lymphedemic patients. The results showed that CDT can effectively reduce the edema volume[MD=-368.85, 95%CI(-465.53~-272.17), P<0.001]. Through descriptive analysis, it was found that CDT can effectively reduce pain, improve shoulder joint function and alleviate depression, but there was inconsistency in the results of studies on the impact CDT of quality of life. Conclusion CDT has certain positive effects on the volume of lymphedema, pain, depression, edema of limbs and shoulder joint function after breast cancer surgery, and its effects on the quality of life need to be further studied.

Key words: breast cancer, lymphedema, complex decongestive therapy, systematic review

中图分类号: 

  • R473.73
[1] 徐文龙. 对淋巴系统的综合认识[J].大家健康(学术版),2015,9(9):269-270.
[2] Tsuchiya M, Horn S, Ingham R.Social Disclosure about Lymphoedema Symptoms:A Qualitative Study among Japanese Breast Cancer Survivors[J]. Psychol Health Med, 2015, 20(6):680-684. DOI:10.1080/13548506.2014.986140.
[3] Merchant S J, Chen S L.Prevention and Management of Lymphedema after Breast Cancer Treatment[J]. Breast J, 2015, 21(3):276-284. DOI:10.1111/tbj.12391.
[4] 敖炼,李红梅.乳腺癌术后患者淋巴水肿真实体验质性研究的系统评价[J].解放军护理杂志,2018,5(20):23-28. DOI: 10.3969/j.issn.1008-9993.2018.20.005.
[5] Boyages J, Xu Y, Kalfa S, et al.The Financial Cost of Lymphedema Borne by Women with Breast Cancer[J]. Psychooncology, 2016. DOI:10.1002/pon.4239.
[6] Taghian N R, Miller C L, Jammallo L S, et al.Lymphedema Following Breast Cancer Treatment and Impact on Quality of Life: A Review[J]. Crit Rev Oncol Hematol, 2014, 92(3):227-234. DOI:10.1016/j.critrevonc.2014.06.004.
[7] Aloisio D C V R, Allini M D C, Josue L D S, et al. Risk Factors for Arm Lymphedema in a Cohort of Breast Cancer Patients Followed up for 10 Years[J]. Breast Care (Basel), 2015,11(1):45-50.DOI:10.1159/000442489. Epub 2015 Dec 14.
[8] Rebegea L, Firescu D, Dumitru M, et al.The Incidence and Risk Factors for Occurrence of Arm Lymphedema after Treatment of Breast Cancer[J]. Chirurgia, 2015, 110(1):33. DOI:10.2459/JCM.0b013e328365ca31.
[9] 何金玲,韦文贞,吴隆燕,等.乳腺癌术后上肢淋巴水肿综合消肿治疗的研究进展[J].当代护士(中旬刊),2018,25(2):1-3.
[10] Hutchison N A.Diagnosis and Treatment of Edema and Lymphedema in the Cancer Patient[J]. Rehabil Nurs, 2018, 43(4):E13. DOI:10.1097/rnj.0000000000000177.
[11] Ezzo J, Manheimer E, McNeely ML, et al. Manual Lymphatic Drainage for Lymphedema Following Breast Cancer Treatment[J]. Cochrane Library,2015, 5(5):1-62. DOI:10.1002/14651858.CD003475.
[12] 周英凤,顾莺,胡雁,等.JBI循证卫生保健中心关于不同类型研究的质量评价工具-干预性研究的质量评价[J].护士进修杂志,2018, 33(2):112-113.DOI:10.1682/j.cnki.hsjx.2018.02.006.
[13] Atalay O T, Özkir A, Çalik B B, et al.Effects of Phase I Complex Decongestive Physiotherapy on Physical Functions and Depression Levels in Breast Cancer Related Lymph Edema[J]. J Phys Ther Sci, 2015, 27(3):865-870. DOI:10.1589/jpts.27.865.
[14] Haghighat S, Lotfitokaldany M, Maboudi A K, et al.Predictive Factors OF Response to Phase I Complete Decongestive Therapy in Upper Extremity Lymphedema Following Breast Carcinoma in IRAN[J]. Lymphology, 2013, 46(2):97-104. DOI:10.3201/eid1906.AC1906.
[15] Hamner J B, Fleming M D.Lymphedema Therapy Reduces the Volume of Edema and Pain in Patients with Breast Cancer[J]. Ann Surg Oncol, 2007, 14(6):1904-1908. DOI:10.1245/s10434-006-9332-1.
[16] Hwang J M, Hwang J H, Kim T W, et al.Long Term Effects of Complex Decongestive Therapy in Breast Cancer Patients with Arm Lymphedema after Axillary Dissection[J]. PM&R, 2013, 5(9):S222. DOI:10.1016/j.pmrj.2013.08.339.
[17] Karadibak D, Al E.Prospective Trial of Intensive Decongestive Physiotherapy for Upper Extremity Lymphedema[J]. J Surg Oncol,2008, 97(7):572-577. DOI:10.1002/jso.21035.
[18] Karadibak D, Yildirim Y, Kara B, et al.Effect of Complex Decongestive Therapy on Upper Extremity Lymphedema[J]. Physioth Rehabil, 2009, 20(1):3-8.
[19] Kim S J, Yi C H, Kwon O Y.Effect of Complex Decongestive Therapy on Edema and the Quality of Life in Breast Cancer Patients with Unilateral Lymphedema[J]. Lymphology, 2007, 40(3):143. DOI:10.1021/jf051228e.
[20] Liao S F, Li S H, Huang H Y, et al.The Efficacy of Complex Decongestive Physiotherapy (CDP) and Predictive Factors of Lymphedema Severity and Response to CDP in Breast Bancer-related Lymphedema (BCRL)[J]. The Breast, 2013, 22(5):703-706. DOI:10.1016/j.breast.2012.12.018.
[21] Ozcan S D, Dalyan M, Unsal Delialioglu S, et al.Complex Decongestive Therapy Enhances Upper Limb Functions in Patients with Breast Cancer-related Lymphedema[J]. Lymphat Res Biol, 2018,16(5):446-452. DOI:10.1089/lrb.2017.0061.
[22] Randheer S, Bhanumathy M, Bhuvaneswari V, et al.Comprehensive Decongestive Therapy in Postmastectomy Lymphedema:An Indian perspective[J]. Indian J Cancer, 2012, 48(4):397-402. DOI:10.4103/0019-509X.92250.
[23] Yesil H, Eyigor S, Caramat I.Effects of Complex Decongestive Therapy on Quality of Life, Depression, Neuropathic Pain, and Fatigue in Women with Breast Cancer-related Lymphedema[J]. Phys Med and Rehabil, 2017, 63(4):329-334.DOI:10.5606/tftrd.2017,779.
[24] 李晓瑾,李文姬,周春兰,等.徒手淋巴引流法联合功能锻炼对乳腺癌术后患者生活质量的影响[J].广东医学,2018,39(2):316-319. DOI:10.13820/j.cnki.gdyx.2018.02.030.
[25] Alcorso J, Sherman K A.Factors Associated with Psychological Distress in Women with Breast Cancer-related Lymphedema[J]. Psychooncology, 2016, 25(7):865-872.DOI:10.1002/pon.4021.
[26] 吴婧. 乳腺癌根治术后颈肩部疼痛功能障碍评估及影响因素分析[D]. 天津:天津体育学院,2017.
[27] Park, Jin-Hyuck.The Effects of Complex Exercise on Shoulder Range of Motion and Pain for Women with Breast Cancer-related Lymphedema: A Single-blind, Randomized Controlled Trial[J]. Breast Cancer, 2017, 24(4):608-614. DOI:10.1007/s12282-016-0747-7.
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