弱激光联合综合消肿治疗乳癌相关淋巴水肿的临床疗效  

Joint Effectiveness of Complex Decongestive Therapy and Low Level Laser Therapy on Management of Breast Cancer Related Lymphedema

作　　者：严瑾 张青[1] 戴璐[1] 杨瑛[1] 韩青 张敏[1] 路莹 YAN Jin;ZHANG Qing;DAI Lu;YANG Ying;HAN Qing;ZHANG Min;LU Ying(Huai'an NO.1 People's Hospital Affiliated to Nanjing Medical University,Huai'an 223300,China)

机构地区：[1]南京医科大学附属淮安第一医院,淮安市223300

出　　处：《中国激光医学杂志》2023年第3期144-151,共8页Chinese Journal of Laser Medicine & Surgery

基　　金：淮安市卫生健康科研项目(HAWJ201908)。

摘　　要：目的探讨弱激光疗法(low level laser therapy,LLLT)联合综合消肿治疗(complex decongestive therapy,CDT)对乳癌相关淋巴水肿(breast cancer related lymphedema,BCRL)患者的治疗效果。方法选择2019年8月至2021年5月,确诊BCRL患者150例,采用随机数字表法分为对照组和治疗组,每组患者各75例,对照组采用CDT,治疗组在CDT的基础上联合LLLT,激光波长590 nm,功率密度25 mW/cm^(2),照射10 min后改用波长830 nm激光照射10 min,功率密度为33 mW/cm^(2)。治疗前、首次治疗后3 d、首次治疗后14 d、首次治疗后1个月和6个月采用肢体周径比率评价患者淋巴水肿严重程度。治疗前及两组首次治疗后6个月,比较患肢水分比率评价患者淋巴水肿严重程度,治疗前及两组首次治疗后6个月采用简明健康调查问卷及癌症康复评价简表评价患者的生活质量。记录两组患者治疗期间不良反应发生情况。结果两组患者治疗前在年龄、体质指数、肿块部位、癌症分期、淋巴水肿分期、肢体周径比率、患肢水分比率、简明健康调查问卷得分及癌症康复评价简表得分等方面比较差异均无统计学意义(P>0.05),具有可比性。两组首次治疗后3 d和两组首次治疗后14 d治疗组与对照组肢体周径比率比较均无明显差异(P>0.05),但在Ⅱ期以上淋巴水肿患者中,治疗组肢体周径比率显著低于对照组(P<0.05);两组首次治疗后1个月及两组首次治疗后6个月治疗组肢体周径比率均明显低于对照组(P<0.05);两组首次治疗后1个月,治疗组患者患肢水分比率明显低于对照组(P<0.05)。两组首次治疗后1个月,治疗组简明健康调查问卷评分明显高于对照组(P<0.001),癌症康复评价简表评分明显低于对照组(P<0.001)。两组患者治疗期间未发生严重不良反应。结论CDT联合LLLT可以减轻乳腺癌相关淋巴水肿患者淋巴水肿的严重程度,提高患者的生活质量。ObjectiveTo explore the effect of complex decongestive therapy combined with low level laser therapy on patients with breast cancerrelated lymphedema.Methods Totally 150 patients with BCRL diagnosed between Aug.2019 and May 2021 were selected and divided randomly into a control group and a treatment group.The patients in the control group were treated solely with CDT,and those in the treatment group were given LLLT in addition.The severity of lymphedema was evaluated with the circumferenee ratio of the limb for each group before the treatment and 3 d,14 d,one month and six months after the first treatment respectively.For both groups,before the treatment and six months after the first treatment,the extracellular water/total body water ratio was used to evaluate the severity of lymphedema respectively,and the life quality of the patients was evaluated with MOS 36-item short form health survey and cancer rehabilitation evaluation system short form respectively.Results Before the treatment,there was no significant difference between two groups in terms of age,body mass index,tumor site,cancer stage,lymphedema stage,circumferenee ratio of limb,extracellular water/total body water ratio,MOS 36-item short form health survey score and cancer rehabilitation evaluation system short form score(P>0.05).The circumstances of the two groups of patients are comparable.The difference between two groups in circumferenee ratio of limb was not significant 3 d and 14 d after the first treatment,but the ratio was much lower in the treatment group than in the control group for patients of stage I or higher level lymphedema(P<0.05).The circumferenee ratio of limb was much lower in the treatment than in the control group one month and six months after the first treatment(P<0.05).Six months after the first treatment,the extracellular water/total body water ratio was much lower in the treatment group than in the control group(P<0.05),the score of MOS 36-item short form health survey much higher in the treatment group than in the control g

关 键 词：弱激光疗法 乳腺相关淋巴水肿 综合消肿治疗 

分 类 号：R730.57[医药卫生—肿瘤] R737.9[医药卫生—临床医学]