Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
Clin Breast Cancer. 2022 Jul;22(5):e664-e673. doi: 10.1016/j.clbc.2022.01.013. Epub 2022 Feb 24.
The purpose of this systematic review was to meta-analyze the effectiveness of manual lymphatic drainage (MLD) in breast cancer-related lymphedema (BCRL) patients.
The following databases: the Cochrane Library, the Cochrane Central Register of Controlled Trials, PubMed, EMBASE, Web of Science, ClinicalTrials.gov were systematically searched. All English publications before April 2021 have been retrieved without any restrictions of countries, time, or article type. We included randomized controlled trials (RCTs) examining the effectiveness of MLD versus control group without MLD of women with BCRL. The outcomes were (1) the incidence of lymphedema, (2) volumetric changes of lymphedema, (3) pain, (4) quality of life. Review Manager 5.3 was used to perform statistical analysis.
In total, 11 RCTs involving 1564 patients were included, in which 10 trials were deemed viable for inclusion in the meta-analysis. Due to the effects of MLD for BCRL, statistically significant improvements were found on the incidence of lymphedema (RR = 0.58, 95% CI [0.37, 0.93], P =.02) and pain intensity (SMD = -0.72, 95% CI [-1.34, -0.09], P = .02). Besides, the meta-analysis carried out implied that the effects that MLD had on volumetric changes of lymphedema and quality of life, were not statistically significant.
The current evidence based on the RCTs shows that pain of BCRL patients undergoing MLD is significantly improved, while our findings do not support the use of MLD in improving volumetric of lymphedema and quality of life. Note that the effect of MLD for preventing BCRL is worthy of discussion.
本系统评价的目的是对乳腺癌相关淋巴水肿（BCRL）患者行手动淋巴引流（MLD）的效果进行荟萃分析。
系统检索了 Cochrane 图书馆、Cochrane 对照试验中心注册库、PubMed、EMBASE、Web of Science、ClinicalTrials.gov 等数据库。检索了截至 2021 年 4 月前发表的所有英文文献，对国家、时间和文章类型均无限制。纳入了比较 MLD 与不进行 MLD 的 BCRL 女性对照组的有效性的随机对照试验（RCT）。结局指标包括（1）淋巴水肿的发生率，（2）淋巴水肿的体积变化，（3）疼痛，（4）生活质量。使用 Review Manager 5.3 进行统计分析。
共纳入 11 项 RCT，涉及 1564 例患者，其中 10 项试验被认为适合纳入荟萃分析。由于 MLD 对 BCRL 的影响，在淋巴水肿发生率（RR=0.58，95%CI[0.37,0.93]，P=0.02）和疼痛强度（SMD=-0.72，95%CI[-1.34，-0.09]，P=0.02）方面有统计学意义的改善。此外，荟萃分析表明 MLD 对淋巴水肿体积变化和生活质量的影响没有统计学意义。
基于 RCT 的现有证据表明，接受 MLD 的 BCRL 患者的疼痛明显改善，但我们的研究结果并不支持 MLD 用于改善淋巴水肿的体积和生活质量。需要注意的是，MLD 预防 BCRL 的效果值得讨论。
