早期使用压缩衣预防轻度乳腺癌相关上肢淋巴水肿进展：一项随机对照试验。
Early intervention with compression garments prevents progression in mild breast cancer-related arm lymphedema: a randomized controlled trial.
机构信息
Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
Physiotherapy Cancer, Karolinska University Hospital, Stockholm, Sweden.
出版信息
Acta Oncol. 2022 Jul;61(7):897-905. doi: 10.1080/0284186X.2022.2081932. Epub 2022 Jun 3.
BACKGROUND
Early diagnosis and compression treatment are important to prevent progression in breast cancer-related arm lymphedema (BCRAL). However, some mild BCRAL can be reversible, and therefore, compression treatment may not be needed. The aim of this study was to investigate the proportion of women with mild BCRAL showing progression/no progression of lymphedema after treatment with or without compression garments, differences in changes of lymphedema relative volume (LRV), local tissue water and subjective symptoms during 6 months. Also, adherence to self-care was examined.
MATERIAL AND METHODS
Seventy-five women diagnosed with mild BCRAL were randomized to a compression group (CG) or noncompression group (NCG). Both groups received self-care instructions, and the CG were treated with a standard compression garment (ccl 1). Women in the NCG who progressed in LRV ≥2%, or exceeded 10% dropped out, and received appropriate treatment. The proportion showing progression/no progression of LRV, and changes in LRV was measured by Water Displacement Method. Changes in local tissue water were measured by Tissue Dielectric Constant (TDC), subjective symptoms by Visual Analogue Scale, and self-care by a questionnaire.
RESULTS
A smaller proportion of LRV progression was found in the CG compared to the NCG at 1, 2 and 6 months follow-up ( ≤ 0.013). At 6 months, 16% had progression of LRV in the CG, compared to 57% in the NCG, ( = 0.001). Thus, 43% in the NCG showed no progression and could manage without compression. Also, CG had a larger reduction in LRV, at all time-points ( ≤ 0.005), and in the highest TDC ratio, when same site followed, at 6 months ( = 0.025). Subjective symptoms did not differ between the groups, except at 1 month, where the CG experienced more reduced tension ( = 0.008). There were no differences in adherence to self-care.
CONCLUSION
Early treatment with compression garment can prevent progression in mild BCRAL. ISRCT nr ISRCTN51918431.
背景
早期诊断和压缩治疗对于预防乳腺癌相关上肢淋巴水肿（BCRAL）的进展非常重要。然而，一些轻度 BCRAL 可能是可逆的，因此可能不需要进行压缩治疗。本研究旨在探讨接受或不接受压缩衣治疗后，轻度 BCRAL 患者中出现淋巴水肿进展/无进展的女性比例、淋巴水肿相对体积（LRV）变化差异、局部组织水含量变化和主观症状在 6 个月期间的变化，以及自我护理的依从性。
材料和方法
75 名被诊断为轻度 BCRAL 的女性被随机分配到压缩组（CG）或非压缩组（NCG）。两组均接受自我护理指导，CG 接受标准压缩衣（ccl 1）治疗。LRV 增加≥2%或超过 10%的 NCG 患者进展，退出并接受适当治疗。采用排水法测量 LRV 进展/无进展的比例和 LRV 的变化。采用组织介电常数（TDC）测量局部组织水含量的变化，采用视觉模拟量表测量主观症状，采用问卷测量自我护理情况。
结果
CG 在 1、2 和 6 个月随访时的 LRV 进展比例明显小于 NCG（≤0.013）。6 个月时，CG 中有 16%的患者出现 LRV 进展，而 NCG 中有 57%的患者出现进展（=0.001）。因此，NCG 中有 43%的患者无进展，可以不使用压缩治疗。此外，CG 在所有时间点（均≤0.005）和同一部位随访时的 TDC 比值最高时（6 个月，=0.025），LRV 减少幅度更大。两组患者的主观症状无差异，但在 1 个月时，CG 组的张力减轻更多（=0.008）。自我护理的依从性没有差异。
结论
早期使用压缩衣治疗可以预防轻度 BCRAL 的进展。ISRCTN 编号 ISRCTN51918431。
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