Randheer S, Kadambari D, Srinivasan K, Bhuvaneswari V, Bhanumathy M, Salaja R
Department of Surgery, JIPMER, Puducherry, India.
Indian J Cancer. 2011 Oct-Dec;48(4):397-402. doi: 10.4103/0019-509X.92250.
Lymphedema following breast cancer treatment is one of the most morbid conditions affecting breast cancer survivors. Currently, no therapy completely cures this condition. Comprehensive Decongestive Therapy (CDT), a novel physiotherapeutic method offers promising results in managing this condition. This therapy is being widely used in the West. Till date, there are no studies evaluating the effectiveness and feasibility of this therapy in the east.
The therapeutic responses of 25 patients with postmastectomy lymphedema were analyzed prospectively in this study. Each patient received an intensive phase of therapy for eight days from trained physiotherapists, which included manual lymphatic drainage, multi layered compression bandaging, exercises, and skin care. Instruction in self management techniques were given to the patients on completion of intensive therapy. The patients were followed up for three months. Changes in the volume of the edematous limb were assessed with a geometric approximation derived from serial circumference measurements of the limb and by water displacement volumetry. Changes in skin and sub cutis thickness were assessed using high frequency ultrasound.
The reduction in limb volume observed after therapy was 32.3% and 42% of the excess, by measurement and volumetry, respectively. The maximum reduction was obtained after the intensive phase. The reduction in skin and subcutis thickness of the edematous limb followed the same pattern as volume reduction. Patients could maintain the reduction obtained by strictly following the protocols of the maintenance phase.
CDT combined with long-term self management is effective in treating post mastectomy lymphedema. The tropical climate is a major factor limiting the regular use of bandages by the patients.
乳腺癌治疗后的淋巴水肿是影响乳腺癌幸存者的最具致残性的病症之一。目前，尚无疗法能完全治愈这种病症。综合消肿疗法（CDT）是一种新型物理治疗方法，在管理这种病症方面显示出有前景的效果。这种疗法在西方被广泛使用。迄今为止，尚无研究评估该疗法在东方的有效性和可行性。
本研究前瞻性分析了25例乳房切除术后淋巴水肿患者的治疗反应。每位患者接受了来自训练有素的物理治疗师的为期八天的强化治疗阶段，包括手动淋巴引流、多层加压包扎、运动和皮肤护理。强化治疗结束时，向患者提供自我管理技术指导。对患者进行了三个月的随访。通过从肢体的连续周长测量得出的几何近似法和水置换体积测量法评估水肿肢体体积的变化。使用高频超声评估皮肤和皮下组织厚度的变化。
治疗后通过测量和体积测量观察到肢体体积减少分别为多余体积的32.3%和42%。在强化治疗阶段后获得最大减少量。水肿肢体的皮肤和皮下组织厚度的减少与体积减少遵循相同模式。患者通过严格遵循维持阶段的方案可以维持所获得的减少量。
CDT联合长期自我管理对治疗乳房切除术后淋巴水肿有效。热带气候是限制患者定期使用绷带的主要因素。
