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中华乳腺病杂志(电子版) ›› 2022, Vol. 16 ›› Issue (04) : 225 -230. doi: 10.3877/cma.j.issn.1674-0807.2022.04.005

论著

力量训练联合综合消肿治疗对乳腺癌相关淋巴水肿的疗效分析
李丹1, 王寅欢1, 肖佳1, 张晔1, 杨英1,()   
  1. 1. 400038 重庆,陆军军医大学第一附属医院乳腺甲状腺外科
  • 收稿日期:2022-05-17 出版日期:2022-08-01
  • 通信作者: 杨英
  • 基金资助:
    重庆市科卫联合医学科研资助项目(2020FYYX027)

Efficacy of strength training combined with complex decongestivetherapy on breast cancer-related lymphedema

Dan Li1, Yinhuan Wang1, Jia Xiao1, Ye Zhang1, Ying Yang1,()   

  1. 1. Department of Breast and Thyroid Surgery, First Affiliated Hospital of Army Medical University, Chongqing 400038, China
  • Received:2022-05-17 Published:2022-08-01
  • Corresponding author: Ying Yang
引用本文:

李丹, 王寅欢, 肖佳, 张晔, 杨英. 力量训练联合综合消肿治疗对乳腺癌相关淋巴水肿的疗效分析[J/OL]. 中华乳腺病杂志(电子版), 2022, 16(04): 225-230.

Dan Li, Yinhuan Wang, Jia Xiao, Ye Zhang, Ying Yang. Efficacy of strength training combined with complex decongestivetherapy on breast cancer-related lymphedema[J/OL]. Chinese Journal of Breast Disease(Electronic Edition), 2022, 16(04): 225-230.

目的

探讨力量训练联合综合消肿治疗对乳腺癌术后淋巴水肿患者的有效性。

方法

选取2020年1月至2020年12月陆军军医大学第一附属医院乳腺甲状腺外科收治的乳腺癌术后Ⅱ期淋巴水肿患者121例进行回顾性分析,其中对照组61例,试验组60例。对照组患者接受淋巴水肿综合消肿治疗和传统患肢锻炼法;试验组在对照组的基础上进行上肢力量训练。在治疗后第1、3、6、12个月时,分别测量患侧上肢周径,采用Constant-Murley量表中肌力评价部分对患者患肢肌力进行评价,采用乳腺癌患者生活质量测定量表(FACT-B)评估患者生活质量。年龄、BMI的组间比较采用独立样本t检验;文化程度、临床分期的组间比较采用非参数检验;肿瘤位置、病理类型和手术方式的组间比较采用χ2检验;患肢周径、患肢肌力评分、FACT-B评分的组间比较采用重复测量方差分析。

结果

(1)试验组患者的上肢周径小于对照组(腕横纹上10 cm:组间比较,F=6.219,P=0.014;时间点比较,F=578.971,P<0.001;交互作用,F=62.754,P<0.001;腕横纹上20 cm:组间比较,F=9.526,P=0.003;时间点比较,F=451.511,P<0.001;交互作用,F=54.708,P<0.001;腕横纹上40 cm:组间比较,F=8.302,P=0.005;时间点比较,F=777.974,P<0.001;交互作用,F=8.224,P<0.001)。(2)试验组患者肌力评分优于对照组(组间比较:F=35.957,P<0.001;时间点比较:F=327.597,P<0.001;交互作用:F=7.842,P<0.001)。(3)试验组患者FACT-B评分也优于对照组(生理状况:组间比较,F=24.865,P<0.001;时间点比较,F=318.379,P<0.001;交互作用,F=16.658,P<0.001;社会家庭状况:组间比较,F=30.618,P<0.001;时间点比较,F=348.141,P<0.001;交互作用,F=4.118,P=0.004;功能状况:组间比较,F=37.735,P<0.001;时间点比较,F=530.663,P<0.001;交互作用,F=20.687,P<0.001;情感状况:组间比较,F=13.306,P<0.001;时间点比较,F=273.385,P<0.001;交互作用,F=22.092,P<0.001;附加关注:组间比较,F=5.505,P=0.021;时间点比较,F=419.971,P<0.001;交互作用,F=19.545,P<0.001;总分:组间比较,F=107.799,P<0.001;时间点比较,F=1 535.378,P<0.001;交互作用,F=81.933,P<0.001)。

结论

力量训练联合综合消肿治疗可以增强患者患肢肌力,明显提高综合消肿治疗的效果,有效地减轻上肢淋巴水肿程度,从而提高患者的生活质量。

Objective

To investigate the efficacy of strength training combined with complex decongestive therapy on lymphedema in breast cancer patients after surgery.

Methods

A total of 121 patients with postoperative stage II lymphedema after breast cancer surgery in the Department of Breast and Thyroid Surgery, First Affiliated Hospital of Army Medical University from January 2020 to December 2020 were enrolled for a retrospective analysis, including 61 cases in control group and 60 cases in experimental group. The patients in control group received complex decongestive treatment and traditional limb exercise; the patients in experimental group received additional strength training of upper limbs. At 1, 3, 6, 12 months after treatment, the circumference of the upper limbs on the affected side was measured respectively, and the muscle strength of the affected limb was evaluated by the Constant-Murley scale. The quality of life in breast cancer patients was measured by the Functional Assessment of Cancer Therapy-Breast (FACT-B) questionnaire. Age and BMI were compared between groups by independent sample t test; education and clinical stage were compared by nonparametric test; tumor location, pathological type and surgical method were compared by χ2 test; limb circumference, muscle strength and FACT-B scores were compared using repeated-measure analysis of variance.

Results

(1) The upper limb circumference of the patients in experimental group was significantly lower than that in the control group (10 cm above the transverse crease of the wrist: comparison between groups, F=6.219, P=0.014; comparison among time points, F=578.971, P<0.001; interaction, F= 62.754, P<0.001; 20 cm above the transverse crease of the wrist: comparison between groups, F=9.526, P=0.003; comparison among time points, F=451.511, P<0.001; interaction, F=54.708, P<0.001; 40 cm above the transverse crease of the wrist: comparison between groups, F= 8.302, P=0.005; comparison among time points, F=777.974, P<0.001; interaction, F=8.224, P<0.001). (2) The muscle strength score of the patients in experimental group was significantly higher than that in control group (comparison between groups: F=35.957, P< 0.001; comparison among time points: F=327.597, P< 0.001; interaction: F=7.842, P< 0.001). (3) The FACT-B score of the patients in experimental group was significantly higher than that in control group (physical well-being: comparison between groups, F=24.865, P<0.001; comparison among time points, F=318.379, P<0.001; interaction, F=16.658, P<0.001; social/family well-being: comparison between groups, F=30.618, P<0.001; comparison among time points, F=348.141, P<0.001; interaction, F=4.118, P=0.004; functional well-being: comparison between groups, F=37.735, P<0.001; comparison among time points, F=530.663, P<0.001; interaction, F=20.687, P<0.001; emotional well-being: comparison between groups, F=13.306, P<0.001; comparison among time points, F=273.385, P<0.001; interaction, F=22.092, P<0.001; breast cancer subscale: comparison between groups, F=5.505, P=0.021; comparison among time points, F=419.971, P<0.001; interaction, F=19.545, P<0.001; total score: comparison between groups, F=107.799, P<0.001; comparison among time points, F=1 535.378, P<0.001; interaction, F=81.933, P<0.001).

Conclusion

Strength training combined with complex decongestive therapy can enhance the muscle strength of affected limbs, significantly improve the efficacy and reduce the severity of upper limb lymphedema, thereby improving the quality of life of breast cancer patients.

表1 2组乳腺癌相关淋巴水肿患者基线资料比较
表2 2组乳腺癌相关淋巴水肿患者上肢周径比较(cm,±s)
表3 2组乳腺癌相关淋巴水肿患者肌力评分比较(分,±s)
表4 2组乳腺癌相关淋巴水肿患者生活质量测定量表评分比较(分,±s)
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