综合消肿疗法联合淋巴静脉吻合术治疗乳腺癌改良根治术后单侧上肢淋巴水肿的疗效观察

Efficacy observation of complex decongestive therapy combined with lymphovenous anastomosis in the treatment of unilateral upper extremity lymphedema after modified radical mastectomy

摘要:

目的 探讨综合消肿疗法（CDT）联合淋巴静脉吻合术（LVA）治疗乳腺癌改良根治术后单侧上肢淋巴水肿的疗效。方法 选取2025年1月—2025年6月邢台市中心医院腺体外科收治的108例乳腺癌改良根治术后单侧上肢淋巴水肿患者。采用随机数字表法将患者分为对照组与观察组，各54例。对照组采用单纯CDT治疗，观察组在对照组的基础上联合LVA治疗。对比两组患者治疗前、治疗6周、治疗12周患侧上肢周径差、淋巴水肿与乳腺癌问卷（LBCQ）评分、上肢功能评定表（DASH）评分。结果 两组治疗前、治疗6周、治疗12周的肘上10 cm周径差、肘下10 cm周径差、LBCQ评分、DASH评分比较，结果 ①不同时间点肘上10 cm周径差、肘下10 cm周径差、LBCQ评分、DASH评分比较，差异均有统计学意义（P <0.05）；②两组肘上10 cm周径差、肘下10 cm周径差、LBCQ评分、DASH评分比较，差异均有统计学意义（P <0.05），观察组肘上10 cm周径差、肘下10 cm周径差较小，LBCQ评分、DASH评分较低；③两组肘上10 cm周径差、肘下10 cm周径差、LBCQ评分、DASH评分变化趋势比较，差异均有统计学意义（P <0.05）。观察组与对照组不良反应总发生率比较，差异无统计学意义（P >0.05）。结论 CDT联合LVA治疗可改善乳腺癌改良根治术后上肢淋巴水肿，提高上肢功能。

Abstract:

Objective To explore the efficacy of complex decongestive therapy (CDT) combined with lymphovenous anastomosis (LVA) in the treatment of unilateral upper extremity lymphedema after modified radical mastectomy.Methods Between January and June 2025, 108 patients with unilateral upper limb lymphedema following modified radical mastectomy were recruited from the Department of Breast and Thyroid Surgery. Via random number table allocation, they were assigned to a control group (n = 54) receiving CDT alone, and an observation group (n = 54) receiving CDT combined with LVA. Outcome measures comprising upper limb circumference difference, Lymphedema and Breast Cancer Questionnaire (LBCQ) scores, and Disabilities of the Arm, Shoulder and Hand (DASH) scores were assessed at baseline, and at 6 and 12 weeks post-treatment.Results Comparison of the four outcome measures (upper arm circumference difference at 10 cm above the elbow, forearm circumference difference at 10 cm below the elbow, LBCQ score, and DASH score) between the two groups before treatment, at 6 weeks of treatment, and at 12 weeks of treatment showed the following: (1) there were statistically significant differences across different time points in all four measures (all P < 0.05); (2) there were statistically significant differences between the two groups in all four measures (all P < 0.05), with the observation group showing smaller circumference differences and lower LBCQ and DASH scores; (3) the changing trends of all four measures differed significantly between the two groups (all P < 0.05). No statistically significant difference was found in the overall incidence of adverse reactions between the two groups (P > 0.05).Conclusion CDT combined with LVA can effectively improve upper extremity lymphedema and enhance upper extremity function in patients after modified radical mastectomy.