CAJ | 학술논문

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（d<1~2 cm）、B组（5 cm≥d≥2 cm）、C组（d>5 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 Deconges-tive 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（P<0.01），组间比较水分比率与周径比率治疗后下降量C组>B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。
목적：탐토운용수법림파인류（Manual Lymph Drainage，MLD）치료유선암술후상지림파수종적료효。방법2008년지2012년，101례유선암술후상지림파수종환자안치료전환지여건지적주경（d）차치분3조：A조（d<1~2 cm）、B조（5 cm≥d≥2 cm）、C조（d>5 cm）。3조환자균진행1개료정（15 d）적림파수종종합소종치료（Complex Deconges-tive Therapy，CDT）：수법림파인류＋저탄성붕대포찰。통과검측인류전후건환측적조직수분화지체주경，계산수분비솔여주경비솔，동시조사환자대수법인류급붕대사용정황적주관감수，이관찰병평개환자대치료적괄응성화접수도。조직수분채용다빈생물전조인체성분분석의진행검측。결과101례환자경CDT치료후，환지조직수분화지체주경균정현저하강（P<0.01），조간비교수분비솔여주경비솔치료후하강량C조>B조>A조（P<0.01），즉치료효과여수종엄중정도성정비。궤호소유환자대치료방법급효과표시만의。결론 CDT능유효촉진유선암술후상지림파수종적림파회류，감경환지수종，개선환지외형，방조공능회복，병차해치료대수종정도교중적환자료효우기현저。
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.