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中华损伤与修复杂志(电子版)

中华损伤与修复杂志(电子版) ›› 2024, Vol. 19 ›› Issue (03) : 198 -203. doi: 10.3877/cma.j.issn.1673-9450.2024.03.003

淋巴水肿

采用综合消肿疗法联合淋巴管-静脉吻合术治疗继发性淋巴水肿的临床效果
王季1, 王淑婷1, 肖聪慧1, 廖鑫1, 严鹭慧1, 徐姗姗1, 邓呈亮2, 王玉龙1,†()   
  1. 1. 518121　深圳市大鹏新区南澳人民医院康复科
    2. 563003　遵义医科大学附属医院烧伤整形外科
  • 收稿日期:2024-03-16 出版日期:2024-06-01
  • 通信作者: 王玉龙
  • 基金资助:
    深圳市大鹏新区医疗健康集团医疗卫生科研基金项目(2022JTLCYJ07)

Clinical efficacy of complex decongestive therapy combined with lymphaticovenular anastomosis in the treatment of secondary lymphedema

Ji Wang1, Shuting Wang1, Conghui Xiao1, Xin Liao1, Luhui Yan1, Shanshan Xu1, Chengliang Deng2, Yulong Wang1,†()   

  1. 1. Department of Rehabilitation, Shenzhen Dapeng New Area Nan′ao People′s Hospital, Shenzhen 518121, China
    2. Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China
  • Received:2024-03-16 Published:2024-06-01
  • Corresponding author: Yulong Wang
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王季, 王淑婷, 肖聪慧, 廖鑫, 严鹭慧, 徐姗姗, 邓呈亮, 王玉龙. 采用综合消肿疗法联合淋巴管-静脉吻合术治疗继发性淋巴水肿的临床效果[J]. 中华损伤与修复杂志(电子版), 2024, 19(03): 198-203.

Ji Wang, Shuting Wang, Conghui Xiao, Xin Liao, Luhui Yan, Shanshan Xu, Chengliang Deng, Yulong Wang. Clinical efficacy of complex decongestive therapy combined with lymphaticovenular anastomosis in the treatment of secondary lymphedema[J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2024, 19(03): 198-203.

目的

比较综合消肿治疗(CDT)联合淋巴管-静脉吻合术(LVA)与单纯CDT对继发性淋巴水肿的临床疗效。

方法

选取2023年3月至7月深圳市大鹏新区南澳人民医院康复科收治的33例继发性下肢淋巴水肿患者。根据是否行LVA分为CDT联合LVA组及CDT组，其中CDT联合LVA组12例，CDT组21例。CDT组采用标准CDT治疗，CDT联合LVA组在CDT的基础上，采用LVA治疗。比较两组治疗前、治疗1个月及随访6个月患肢周径、视觉模拟量表(VAS)评分及生活质量核心问卷量表(QLQ-C30)评分。

结果

两组患者治疗1个月患肢周径、VAS评分及QLQ-C30评分均较治疗前显著改善，差异有统计学意义(P<0.05)，两种治疗方式均可改善患肢肿胀、疼痛及生活质量。CDT联合LVA组与CDT组比较，患肢踝部[(3.00±1.49)cm vs (1.35±1.08)cm]、髌骨下缘下10 cm[(2.87±1.51)cm vs (1.64±1.25)cm ]、膝中[(3.50±2.44) cm vs (1.34±1.27)cm]、髌骨上缘上10 cm[ (3.87±1.94) cm vs (1.67±1.17)cm ]周径，VAS评分[(4(3，5)分vs 3(2，4)分]及QLQ-C30评分[(11.50±4.40)分vs (7.43±2.42)分]治疗前后差值差异均有统计学意义(P<0.05)，CDT联合LVA组较CDT组改善更明显。随访6个月，CDT联合LVA组患肢踝部、髌骨下缘下10 cm、膝中、髌骨上缘上10 cm处周径相较于治疗1个月差异无统计学意义(P>0.05)，CDT组相较于治疗1个月差异有统计学意义(P<0.05)。

结论

CDT联合LVA能较大程度改善继发性淋巴水肿患者肢体肿胀程度，缓解疼痛，提高生活质量，其效果优于单纯CDT，且短中期疗效较佳。

关键词: 综合消肿治疗, 淋巴管-静脉吻合术, 继发性淋巴水肿, 肢体周径
Objective

To compare the clinical efficacy of complex decongestive therapy (CDT) combined with lymphaticovenular anastomosis (LVA) and CDT alone in the treatment of secondary lymphedema.

Methods

Thirty-three patients with secondary lower limb lymphedema admitted to the Rehabilitation Department of Shenzhen Dapeng New Area Nan′ao People′s Hospital from March 2023 to July 2023 were selected. The patients were divided into CDT combined with LVA group and CDT group according to underwent LVA or not, among which 12 cases were in CDT combined with LVA group and 21 cases were in CDT group.The CDT group were treated with standard CDT, and the CDT combined with LVA group were treated with LVA on the basis of CDT. The circumference of the affected limb, VAS score, and QLQ-C30 score were compared between the two groups before treatment, after 1 month of treatment, and 6-month follow-up.

Results

The circumference of the affected limb, VAS score, and QLQ-C30 score of both groups improved significantly compared with pre-treatment, and the differences were statistically significant (P<0.05).Both treatment modalities improved the symptoms of swelling, pain, and quality of life. There were statistically significant differences in the change of circumference of the affected limbs at the ankle[(3.00±1.49)cm vs (1.35±1.08)cm], 10 cm below the inferior border of the patella[(2.87±1.51)cm vs (1.64±1.25)cm ], mid-knee[(3.50±2.44)cm vs (1.34±1.27)cm], 10 cm above the superior border of the patella[ (3.87±1.94)cm vs (1.67±1.17)cm ], VAS scores[(4(3, 5) vs 3(2, 4)], and QLQ-C30 scores[(11.50±4.40) vs (7.43±2.42)] between the two groups, and the improvement was more pronounced in the CDT combined with LVA group compared with that in the CDT group. At 6-month follow-up, no significant difference was found in the circumference of the affected limb at the ankle, 10 cm below the inferior border of the patella, mid-knee, and 10 cm above the superior border of the patella in the CDT combined with LVA group compared with that after 1 month of treatment (P>0.05), and the difference in the CDT group was significant compared with that after 1 month of treatment (P<0.05).

Conclusion

CDT combined with LVA can improve the degree of swelling, relieve pain, and improve the quality of life of patients with secondary lymphedema to a greater extent, and its effect is better than that of CDT alone, and the short- and medium-term efficacy is better.

Key words: Complex decongestive therapy, Lymphaticovenular anastomosis, Secondary lymphedema, Limb circumference
表1 两组患者临床资料比较
项目 CDT联合LVA组(n＝12) CDT组(n＝21) t值/χ2值 P值
性别[例(男/女)] 0/12 1/20 0.589 1.000
年龄(岁，±s) 60.25±6.08 54.10±11.58 1.704 0.098
肿瘤确诊时间(年，±s) 7.33±3.60 5.43±3.46 1.500 0.144
淋巴水肿时间(年，±s) 4.92±2.58 3.41±2.44 1.680 0.103
受累肢体[例(%)]     0.488 0.629
左下肢 4(33.3) 12(57.1)    
右下肢 8(66.7) 9(42.9)    
淋巴水肿分期[例(%)]     1.311 0.200
Ⅱ期 9(75.0) 14(66.7)    
Ⅲ期 3(25.0) 7(33.3)    
表2 两组患者治疗前、治疗1个月及随访6个月患肢周径、VAS评分和QLQ-C30评分比较
指标 例数 治疗前 治疗1个月 随访6个月
踝部周径(cm，±s)        
CDT联合LVA组 12 26.38±2.12 23.38±1.19a 23.42±1.23
CDT组 21 25.55±3.01 24.20±2.56a 24.87±2.71b
髌骨下缘下10 cm周径(cm，±s)        
CDT联合LVA组 12 38.68±3.94 35.81±3.86a 35.89±3.89
CDT组 21 37.33±3.49 35.59±3.10a 36.56±3.37b
膝中周径(cm，±s)        
CDT联合LVA组 12 40.22±3.80 36.72±2.77a 36.81±2.76
CDT组 21 38.39±2.90 37.05±2.18a 37.74±2.44 b
髌骨上缘上10 cm周径(cm，±s)        
CDT联合LVA组 12 48.83±3.78 44.96±3.68a 45.03±3.74
CDT组 21 47.37±5.11 45.71±4.59a 46.62±4.88 b
VAS评分[分，M(Q1，Q3)]        
CDT联合LVA组 12 5.00(4.00，5.75) 1.00(0.00，1.00)a 1.00(0.00，1.00)
CDT组 21 4.00(3.00，6.00) 1.00(0.00，2.00)a 2.00(1.00，3.50) b
QLQ-C30评分(分，±s)        
CDT联合LVA组 12 62.00±4.95 50.50±1.98a 50.67±1.97
CDT组 21 59.19±3.86 51.76±3.11a 55.43±4.34b
表3 两组患者患肢周径、VAS评分及QLQ-C30评分治疗前后差值比较
组别 患肢周径(cm) VAS评分(分) QLQ-C30评分(分)
踝部 髌骨下缘下10 cm 膝中 髌骨上缘上10 cm
CDT联合LVA组 3.00±1.49 2.87±1.51 3.50±2.44 3.87±1.94 4(3，5) 11.50±4.40
CDT组 1.35±1.08 1.64±1.25 1.34±1.27 1.67±1.17 3(2，4) 7.43±2.42
t值/Z值 3.674 2.541 3.369 4.099 2.281 2.960
P值 0.001 0.016 0.002 0.000 0.023 0.010
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