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

doi:10.3877/cma.j.issn.1673-9450.2024.03.003

Abstract

Abstract:

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

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.

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References 25

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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)

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)

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±1.19^a	23.42±1.23
CDT组	21	25.55±3.01	24.20±2.56^a	24.87±2.71^b
髌骨下缘下10 cm周径(cm，±s)
CDT联合LVA组	12	38.68±3.94	35.81±3.86^a	35.89±3.89
CDT组	21	37.33±3.49	35.59±3.10^a	36.56±3.37^b
膝中周径(cm，±s)
CDT联合LVA组	12	40.22±3.80	36.72±2.77^a	36.81±2.76
CDT组	21	38.39±2.90	37.05±2.18^a	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±3.68^a	45.03±3.74
CDT组	21	47.37±5.11	45.71±4.59^a	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±1.98^a	50.67±1.97
CDT组	21	59.19±3.86	51.76±3.11^a	55.43±4.34^b

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±1.19^a	23.42±1.23
CDT组	21	25.55±3.01	24.20±2.56^a	24.87±2.71^b
髌骨下缘下10 cm周径(cm，±s)
CDT联合LVA组	12	38.68±3.94	35.81±3.86^a	35.89±3.89
CDT组	21	37.33±3.49	35.59±3.10^a	36.56±3.37^b
膝中周径(cm，±s)
CDT联合LVA组	12	40.22±3.80	36.72±2.77^a	36.81±2.76
CDT组	21	38.39±2.90	37.05±2.18^a	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±3.68^a	45.03±3.74
CDT组	21	47.37±5.11	45.71±4.59^a	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±1.98^a	50.67±1.97
CDT组	21	59.19±3.86	51.76±3.11^a	55.43±4.34^b

组别	患肢周径(cm)				VAS评分(分)	QLQ-C30评分(分)
组别	踝部	髌骨下缘下10 cm	膝中	髌骨上缘上10 cm	VAS评分(分)	QLQ-C30评分(分)
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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