乳腺癌症手术后的淋巴水肿护理：来自新的Meta-Analysis的见解

摘要(中文译文)

淋巴水肿是乳腺癌术后常见并发症，显著影响生活质量。本研究旨在综合现有证据，探讨乳腺癌术后淋巴水肿护理的有效干预措施。在PubMed、Cochrane图书馆和Scopus中进行了系统性文献检索，以识别截至2024年9月发表的随机对照试验和观察性研究。纳入的研究评估了预防和管理淋巴水肿的干预措施，如物理治疗[手动淋巴引流（MLD）、运动]、压力治疗和药物治疗，并报告了淋巴水肿发生率、严重程度或生活质量结局。由两名独立评价者提取数据，采用随机效应模型估计合并效应量。亚组分析基于干预类型和研究设计。共纳入9项研究，包含1183例患者。对照组淋巴水肿合并发生率为22.5%[95%置信区间（CI）：19.3%-26.1%]。MLD使淋巴水肿发生率降低38%[风险比（RR）= 0.62，95% CI：0.52-0.74]，而压力治疗使肢体周径减少15%（标准化均数差 = -0.33，95% CI：-0.46至-0.19）。运动方案使风险降低12%（RR = 0.88，95% CI：0.76-1.03）。联合干预，如MLD联合压力衣物，使发生率降低44%（RR = 0.56，95% CI：0.47-0.67），并显著改善生活质量（乳腺癌治疗功能评估平均差异 = 7.4，95% CI：5.1-9.7）。早期和综合护理方法显示出最大获益。本荟萃分析证实了MLD和压力治疗在管理术后淋巴水肿中的有效性。多模式方法为减轻淋巴水肿负担和改善生活质量提供了最佳结局。

Abstract

Lymphedema is a common complication after breast cancer surgery that significantly affects quality of life. This study aimed to synthesize current evidence on effective interventions for lymphedema care postsurgery. A systematic literature search was conducted in PubMed, Cochrane Library, and Scopus to identify randomized controlled trials and observational studies published until September 2024. Included studies evaluated interventions for preventing and managing lymphedema, such as physical therapy [manual lymphatic drainage (MLD), exercise], compression therapy, and pharmacological treatments, reporting on lymphedema incidence, severity, or quality-of-life outcomes. Data were extracted by two independent reviewers, and a random-effects model estimated pooled effect sizes. Subgroup analyses were based on intervention types and design. Nine studies comprising 1183 patients were included. The pooled lymphedema incidence in control groups was 22.5% [95% confidence interval (CI): 19.3%-26.1%]. MLD reduced lymphedema incidence by 38% [risk ratio (RR) = 0.62, 95% CI: 0.52-0.74], whereas compression therapy decreased limb circumference by 15% (standardized mean difference = -0.33, 95% CI: -0.46 to -0.19). Exercise programs offered a 12% risk reduction (RR = 0.88, 95% CI: 0.76-1.03). Combined interventions, such as MLD with compression garments, yielded a 44% reduction in incidence (RR = 0.56, 95% CI: 0.47-0.67) and significantly improved quality of life (mean Functional Assessment of Cancer Therapy-Breast difference = 7.4, 95% CI: 5.1-9.7). Early and integrated care approaches showed the greatest benefit. This meta-analysis confirms MLD and compression therapy's effectiveness in managing postsurgical lymphedema. A multimodal approach provides optimal outcomes for reducing lymphedema burden and improving quality of life.

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