Yao Min, Peng Puchao, Ding Xiufang, Sun Qinfang, Chen Lijie
Department of Breast Surgery, Huzhou Maternity and Child Health Care Hospital, Huzhou, China.
Breast Care (Basel). 2024 Jun;19(3):155-164. doi: 10.1159/000538940. Epub 2024 Apr 22.
Breast cancer is among the most prevalent malignancies in women worldwide, with substantial morbidity and mortality. Upper limb lymphedema (ULL) is a common complication after breast cancer surgery that affects patients' daily activities and quality of life. Decongestive lymphatic therapy (DLT) and intermittent pneumatic compression (IPC) therapy are 2 primary treatment methods for ULL.
This study aimed to compare the efficacy of DLT with IPC versus DLT alone in the management of ULL following breast cancer surgery.
PubMed Central, SCOPUS, EMBASE, MEDLINE, Cochrane Trial Registry, Google Scholar, and Clinicaltrials.gov databases were comprehensively searched for randomized controlled trials (RCTs) comparing DLT with IPC and DLT alone in patients with breast cancer-related ULL. The risk of bias was evaluated using the RoB 2 tool. Pooled effect sizes were calculated using random-effects models.
A total of 1,894 citations were identified by the systematic search. Of them, 9 RCTs were included in the analysis. The pooled standardized mean difference (SMD) for percentage volume reduction was 0.63 (95% confidence interval [CI]: -0.24 to 1.50; = 90.9%), showing no significant difference between the DLT alone and DLT combined with IPC ( = 0.15). Pain and heaviness scores were also comparable between the groups. However, there was a significant difference in external rotation joint mobility (SMD = 0.62; 95% CI: 0.08-1.16; = 23.8%), favoring DLT with IPC.
Our findings suggest that DLT with IPC and DLT alone showed similar findings in managing ULL after breast cancer surgery, with DLT with IPC showing a greater impact on external rotation joint mobility. Healthcare providers should consider patient preferences and individual factors when selecting the most appropriate treatment modality for ULL management.
乳腺癌是全球女性中最常见的恶性肿瘤之一，具有较高的发病率和死亡率。上肢淋巴水肿（ULL）是乳腺癌手术后的常见并发症，会影响患者的日常活动和生活质量。消肿淋巴治疗（DLT）和间歇性气动压迫（IPC）治疗是ULL的两种主要治疗方法。
本研究旨在比较DLT联合IPC与单纯DLT治疗乳腺癌术后ULL的疗效。
全面检索PubMed Central、SCOPUS、EMBASE、MEDLINE、Cochrane试验注册库、谷歌学术和Clinicaltrials.gov数据库，以查找比较DLT联合IPC与单纯DLT治疗乳腺癌相关ULL患者的随机对照试验（RCT）。使用RoB 2工具评估偏倚风险。采用随机效应模型计算合并效应量。
通过系统检索共识别出1894条引文。其中，9项RCT纳入分析。体积减少百分比的合并标准化均值差（SMD）为0.63（95%置信区间[CI]：-0.24至1.50；I² = 90.9%），表明单纯DLT与DLT联合IPC之间无显著差异（P = 0.15）。两组间疼痛和沉重感评分也相当。然而，在外旋关节活动度方面存在显著差异（SMD = 0.62；95%CI：0.08 - 1.16；I² = 23.8%），DLT联合IPC更具优势。
我们的研究结果表明，DLT联合IPC与单纯DLT在治疗乳腺癌术后ULL方面效果相似，DLT联合IPC在外旋关节活动度方面影响更大。医疗服务提供者在选择ULL管理的最合适治疗方式时应考虑患者偏好和个体因素。
