Wang Shiheng, Zhang Fengxia, Tang Hanqing, Ning Wanling
China Institute for History of Medicine and Medical Literature, China Academy of Chinese Medical Sciences, Beijing, China.
School of Basic Medicine, Youjiang Medical University for Nationalities, Baise, China.
Gland Surg. 2023 Feb 28;12(2):215-224. doi: 10.21037/gs-22-767. Epub 2023 Feb 21.
Breast cancer lymphedema (BCL) is one of the most common complications of breast cancer. Common western medical treatments for BCL, such as western medicine and lymphatic drainage, are ineffective, and recurrence may easily occur, making treatment more challenging and placing a heavier burden on patients. Acupuncture therapy is commonly used to treat BCL in China, and there are many acupuncture therapies, including acupuncture, moxibustion, and the combination of acupuncture and moxibustion. Given the difference in operation difficulty, efficacy and safety of these acupuncture types, how to the most effective therapy is controversial. Therefore, the purpose of this study was to compare the efficacy and safety of different acupuncture and moxibustion methods, so as to provide guidance for clinical practice.
The PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang, VIP, and SinoMed databases were searched to September 30, 2022. Participants were diagnosed with BCL. Acupuncture was used in the intervention group, and other acupuncture were used in the control group. Outcomes included arm circumference, visual analogue scale (VAS), and safety evaluation. Risk of Bias Assessment Tool 2 (ROB2) was used to assess the risk of bias, Stata 16 was used for network meta-analysis.
A total of 7 studies were included, with 422 patients. The interventions included fire acupuncture, acupuncture (face), moxa-moxibustion, heat-sensitive moxibustion, moxibustion [traditional Chinese medicine (TCM)], acupuncture combine with moxibustion, acupoint application. The risk of overall bias was low or some concerns. The meta-analysis showed that: (I) arm circumference: acupuncture combined with moxibustion was superior to acupoint application [mean difference (MD) =-0.54; 95% confidence interval (CI): (-0.67, -0.41); P<0.05]. The surface under the cumulative ranking probability area (SUCRA) ranking results showed that acupuncture combined with moxibustion may be the optimal method. (II) VAS: acupuncture (face) was more effective than acupuncture (body) [MD =-0.85; 95% CI: (-1.09, -0.61); P<0.01]. The SUCRA ranking results showed that acupuncture (face) had the best effect.
Based on the current evidence, acupuncture and moxibustion is of great efficacy and safety for the treatment of BCL. Acupuncture combined with moxibustion is the most effective in reducing the arm circumference, and acupuncture (face) is of the greatest analgesic effect.
乳腺癌淋巴水肿（BCL）是乳腺癌最常见的并发症之一。BCL常见的西医治疗方法，如西药和淋巴引流，效果不佳，且易复发，使治疗更具挑战性，给患者带来更沉重的负担。在中国，针灸疗法常用于治疗BCL，针灸疗法种类繁多，包括针刺、艾灸以及针刺与艾灸结合。鉴于这些针灸类型在操作难度、疗效和安全性方面存在差异，如何选择最有效的疗法存在争议。因此，本研究旨在比较不同针灸和艾灸方法的疗效和安全性，为临床实践提供指导。
检索截至2022年9月30日的PubMed、Web of Science、Embase、Cochrane图书馆、中国知网（CNKI）、万方、维普和中国生物医学文献数据库。参与者被诊断为BCL。干预组采用针刺治疗，对照组采用其他针灸方法。观察指标包括上臂围、视觉模拟量表（VAS）和安全性评估。采用偏倚风险评估工具2（ROB2）评估偏倚风险，使用Stata 16进行网状Meta分析。
共纳入7项研究，422例患者。干预措施包括火针、针刺（面部）、艾灸、热敏灸、艾灸[中医（TCM）]、针刺结合艾灸、穴位贴敷。总体偏倚风险较低或存在一些担忧。Meta分析结果显示：（I）上臂围：针刺结合艾灸优于穴位贴敷[平均差（MD）=-0.54；95%置信区间（CI）：（-0.67，-0.41）；P<0.05]。累积排序概率曲线下面积（SUCRA）排序结果显示，针刺结合艾灸可能是最佳方法。（II）VAS：针刺（面部）比针刺（身体）更有效[MD=-0.85；95%CI：（-1.09，-0.61）；P<0.01]。SUCRA排序结果显示针刺（面部）效果最佳。
基于当前证据，针灸和艾灸治疗BCL疗效显著且安全。针刺结合艾灸在减小上臂围方面最有效，针刺（面部）镇痛效果最佳。
