乳腺癌相关淋巴水肿非药物干预的证据总结

doi:10.3761/j.issn.0254-1769.2023.03.013

摘要/Abstract

摘要：

目的运用循证的方法整合乳腺癌相关淋巴水肿非药物干预的最佳证据，为临床医护人员对淋巴水肿开展规范化评估和管理提供循证依据。方法系统检索各指南网站及中英文数据库有关乳腺癌患者淋巴水肿预防和管理的相关指南、专家共识、系统评价等证据，检索时限为2016年1月—2022年1月。结果共纳入25篇文献，包括6篇指南、4篇专家共识、15篇系统评价，围绕预防性干预、治疗性干预2个方面总结33条最佳证据。结论该研究总结的证据可用于防治乳腺癌淋巴水肿，医护人员需结合文化背景、临床情境、患者意见，为淋巴水肿患者提供针对性的健康指导。

关键词: 乳腺癌, 淋巴水肿, 非药物干预, 证据总结, 循证护理学

Abstract:

Objective To integrate the best evidence of non-pharmacological interventions for breast cancer-related lymphedema with evidence-based methods，and to provide evidence-based bases for standardized evaluation and management of lymphedema for clinical medical staff. Methods The best evidence about the prevention and management of lymphedema in breast cancer patients were searched systematically，such as relevant guidelines，expert consensuses，systematic reviews and so on. The retrieval period was from January 2016 to January 2022. Results A total of 25 pieces of the literature were included，including 6 guidelines，4 expert consensuses and 15 systematic evaluations，and 33 pieces of best evidences were integrated from 2 aspects，namely the preventive intervention and therapeutic intervention. Conclusion The summarized evidence can be used for the prevention and treatment of breast cancer lymphedema，and medical staff should provide specific health guidance for patients with lymphedema based on cultural background，clinical situation，and patients’ opinions.

Key words: Breast Cancer, Lymphedema, Non-pharmacological Intervention, Evidence Summary, Evide-nce-based Nursing

李佳倩, 强万敏, 魏婷婷, 朱明玉, 李苗苗, 沈傲梅, 武佩佩, 王盈. 乳腺癌相关淋巴水肿非药物干预的证据总结[J]. 中华护理杂志, 2023, 58(3): 349-356.

LI Jiaqian, QIANG Wanmin, WEI Tingting, ZHU Mingyu, LI Miaomiao, SHEN Aomei, WU Peipei, WANG Ying. Evidence summary for non-pharmacological interventions of breast cancer-related lymphedema[J]. Chinese Journal of Nursing, 2023, 58(3): 349-356.

图/表 4

图1 文献筛选流程图

Figure 1 Flow chart of literature screening

表1 纳入文献的基本特征（n=25）

Table 1 General characteristics of the included literature（n=25）

表2 纳入指南的质量评价结果（n=6）

Table 2 Quality evaluation of the included guidelines（n=6）

表3 乳腺癌相关淋巴水肿非药物干预的证据整合

Table 3 Evidence summary of non-pharmacological interventions for breast cancer-related lymphedema

参考文献 41

[1]	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3):209-249. DOI URL
[2]	Schmitz KH, Troxel AB, Dean LT, et al. Effect of home-based exercise and weight loss programs on breast cancer-related lymphedema outcomes among overweight breast cancer sur-vivors:the wiser survivor randomized clinical trial[J]. JAMA On-col, 2019, 5(11):1605-1613.
[3]	尤渺宁, 万巧琴. 乳腺癌相关淋巴水肿患者自我护理的研究进展[J]. 中华护理杂志, 2021, 56(3):464-468. DOI URL
	You MN, Wan QQ. Research progress of self-care in patients with breast cancer-related lymphedema[J]. Chin J Nurs, 2021, 56(3):464-468. DOI URL
[4]	徐洁慧, 胡一惠, 陈花, 等. 乳腺癌相关淋巴水肿非手术预防的证据整合[J]. 中国护理管理, 2021, 21(5):720-727.
	Xu JH, Hu YH, Chen H, et al. Evidence integration of non-surgical prevention strategies for lymphedema related to breast cancer[J]. Chin Nurs Manag, 2021, 21(5):720-727.
[5]	赵慧慧, 周春兰, 吴艳妮, 等. 乳腺癌相关淋巴水肿患者运动指导方案的证据总结[J]. 中华护理杂志, 2020, 55(5):779-785. DOI URL
	Zhao HH, Zhou CL, Wu YN, et al. Evidence summary of exercise programs on patients with breast cancer-related lymphedema[J]. Chin J Nurs, 2020, 55(5):779-785. DOI URL
[6]	何向明, 邹德宏. 乳腺癌上肢淋巴水肿治疗进展[J]. 中国肿瘤, 2017, 26(3):210-213.
	He XM, Zou DH. Progress in treatment of lymphedema in patients with breast cancer[J]. China Cancer, 2017, 26(3):210-213.
[7]	Brouwers MC, Kho MEB, Rowman GP, et al. AGREE Ⅱ:advancing guideline development,reporting,and evaluation in health care[J]. Prev Med, 2010, 51(5):421-424. DOI PMID
[8]	顾莺, 张慧文, 周英凤, 等. JBI循证卫生保健中心关于不同类型研究的质量评价工具:系统评价的方法学质量评价[J]. 护士进修杂志, 2018, 33(8):701-703.
	Gu Y, Zhang HW, Zhou YF, et al. JBI evidence-based health center’s quality assessment tool for different types of research:the quality evaluation of diagnostic and economic evaluation[J]. Nurses Train, 2018, 33(8):701-703.
[9]	张方圆, 沈傲梅, 曾宪涛, 等. 系统评价方法学质量评价工具AMSTAR 2解读[J]. 中国循证心血管医学杂, 2018, 10(1):14-18.
	Zhang FY, Shen AM, Zeng XT, et al. An introduction to AMSTAR 2:a critical appraisal tool for systematic reviews[J]. Chin J Evid Based Cardiovasc Med, 2018, 10(1):14-18.
[10]	Runowicz CD, Leach CR, Henry NL, et al. American Cancer Society/American Society of Clinical Oncology breast cancer survivorship care guideline[J]. CA Cancer J Clin, 2016, 66(1):43-73. DOI URL
[11]	Greenlee H, DuPont-Reyes MJ, Balneaves LG, et al. Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment[J]. CA Cancer J Clin, 2017, 67(3):194-232. DOI URL
[12]	Lyman GH, Greenlee H, Bohlke K, et al. Integrative therapies during and after breast cancer treatment:ASCO endorsement of the SIO clinical practice guideline[J]. J Clin Oncol, 2018, 36(25):2647-2655. DOI PMID
[13]	National Institute for Health and Care Excellence(NICE). Early and locally advanced breast cancer:diagnosis and management[EB/OL].(2018-07-18)[2021-09-15]. https://www.nice.org.uk/guidance/ng101.
[14]	Wöckel A, Festl J, Stüber T, et al. Guideline of the DGGG and the DKG(S3-Level,AWMF Registry Number 032/045OL,December 2017)-part 1 with recommendations for the screening,diagnosis and therapy of breast cancer[J]. GebFra Science, 2018, 78(10):927-948.
[15]	Davies C, Levenhagen K, Ryans K, et al. Interventions for breast cancer-related lymphedema:clinical practice guideline from the academy of oncologic physical therapy of APTA[J]. Phys Ther, 2020, 100(7):1163-1179. DOI URL
[16]	McLaughlin SA, Staley AC, Vicini F, et al. Considerations for clinicians in the diagnosis,prevention,and treatment of breast cancer-related lymphedema:recommendations from a multidisciplinary expert ASBrS Panel:part 1:definitions,assessments,education,and future directions[J]. Ann Surg Oncol, 2017, 24(10):2818-2826. DOI PMID
[17]	McLaughlin SA, DeSnyder SM, Klimberg S. Considerations for clinicians in the diagnosis,prevention,and treatment of breast cancer-related lymphedema,recommendations from an expert panel:part 2:preventive and therapeutic options[J]. Ann Surg Oncol, 2017, 24(10):2827-2835. DOI PMID
[18]	河南省肿瘤医院乳腺癌诊疗共识专家团队. 河南省肿瘤医院乳腺癌相关继发性淋巴水肿诊疗专家共识[J]. 中华肿瘤防治杂志, 2019, 26(24):1855-1858.
	Expert Team of Breast Cancer Diagnosis and Treatment Consensus in Henan Cancer Hospital. Expert consensus on diagnosis and treatment of secondary lymphoedema in breast cancer in Henan Cancer Hospital[J]. Chin J Cancer Prev Treat, 2019, 26(24):1855-1858.
[19]	中国抗癌协会乳腺癌专业委员会. 中国抗癌协会乳腺癌诊治指南与规范(2021年版)[J]. 中国癌症杂志, 2021, 31(10):954-1040.
	Chinese Anti-Cancer Association, Committee of Breast Cancer Society. Guidelines and norms of breast cancer diagnosis and treatment of China Anti-Cancer Association(2021 edition)[J]. Chin Oncol, 2021, 31(10):954-1040.
[20]	Chien TJ, Liu CY, Fang CJ. The effect of acupuncture in breast cancer-related lymphoedema(BCRL):a systematic review and meta-analysis[J]. Integr Cancer Ther, 2019, 18:1534735419866910.
[21]	Gursen C, Dylke ES, Moloney N, et al. Self-reported signs and symptoms of secondary upper limb lymphoedema related to breast cancer treatment:systematic review[J]. Eur J Cancer Care, 2021, 30(5):e13440.
[22]	Hasenoehrl T, Palma S, Ramazanova D, et al. Resistance exercise and breast cancer-related lymphedema:a systematic review update and meta-analysis[J]. Support Care Cancer, 2020, 28(8):3593-3603. DOI PMID
[23]	Li JX, Gao J, Song JY, et al. Compression therapy for the patients with breast cancer:a Meta-analysis of randomized controlled trials[J]. Cancer Nurs, 2021, 30(2):12-16.
[24]	Luo X, Chen Y, Chen J, et al. Effectiveness of mobile health-based self-management interventions in breast cancer patients:a Meta-analysi[J]. Support Care Cancer, 2022, 30(3):2853-2876. DOI URL
[25]	Gatt M, Willis S, Leuschner S. A meta-analysis of the effectiveness and safety of kinesiology taping in the management of cancer-related lymphoedema[J]. Eur J Cancer Care, 2017, 26(5):7-12.
[26]	Gimenoe EM, Martin PP, Villanueva IC, et al. Systematic review of the effect of aquatic therapeutic exercise in breast cancer survivors[J]. Eur J Cancer Care, 2022, 31(1):e13535.
[27]	Saraswathi V, Latha S, Niraimathi K, et al. Managing lymphedema,increasing range of motion,and quality of life through yoga therapy among breast cancer survivors:a systematic review[J]. Int J Yoga, 2021, 14(1):3-17. DOI PMID
[28]	Yu S, Zhu L, Xie P, et al. Effects of acupuncture on breast cancer-related lymphoedema:a systematic review and Meta-analysis[J]. Explore (NY), 2020, 16(2):97-102. DOI URL
[29]	Thompson B, Gaitatzis K, Blackwell R, et al. Manual lymphatic drainage treatment for lymphedema:a systematic review of the literature[J]. J Cancer Surviv, 2021, 15(2):244-258. DOI URL
[30]	Tsai CL, Chih YH, Chang WW, et al. Effects of weight reduction on the breast cancer-related lymphedema:a systematic review and Meta-analysis[J]. Breast, 2020, 52:116-121. DOI PMID
[31]	Wanchai A, Armer JM. Manual lymphedema drainage for reducing risk for and managing breast cancer-related lymphedema after breast surgery:a systematic review[J]. Nurs Womens Health, 2021, 25(5):377-383. DOI URL
[32]	Gao Y, Ma T, Han M, et al. Effects of acupuncture and moxibustion on breast cancer-related lymphedema:a systematic review and meta-analysis of randomized controlled trials[J]. Integr Cancer Ther, 2021, 20:15347354211044107.
[33]	李惠萍, 杨娅娟, 苏丹, 等. 不同预防行为对乳腺癌术后淋巴水肿的预防效果Meta分析[J]. 现代预防医学, 2018, 45(5):949-960.
	Li HP, Yang YJ, Su D, et al. The effect of different preventive behaviors of breast cancer-related lymphedema:a Meta-analysis[J]. Mod Prev Med, 2018, 45(5):949-960.
[34]	杨璇, 张海林, 刘玉, 等. 徒手淋巴引流对乳腺癌相关淋巴水肿预防及治疗效果的Meta分析[J]. 中国护理管理, 2019, 19(6):824-829.
	Yang X, Zhang HL, Liu Y, et al. Meta-analysis of manual lym-phatic drainage on prevention and treatment of breast cancer related lymphedema[J]. Chin Nurs Manag, 2019, 19(6):824-829.
[35]	贾莹莹, 曹松梅, 柏素萍, 等. 乳腺癌术后淋巴水肿预防及治疗管理现状的调查研究[J]. 中国实用护理杂志, 2021, 37(7):538-545.
	Jia YY, Cao SM, Bo SP, et al. Investigation on the management status of breast cancer-related lymphedema prevention and treatment[J]. Chin J Prac Nurs, 2021, 37(7):538-545.
[36]	童静韬, 王颖, 倪平, 等. 乳腺癌患者术后肢体功能康复行为的质性研究[J]. 中华护理杂志, 2022, 57(6):711-717. DOI URL
	Tong JT, Wang Y, Ni P, et al. Rehabilitation behavior of limb function in postoperative breast cancer patients based on the theory of planned behavior:a qualitative research[J]. Chin J Nurs, 2022, 57(6):711-717.
[37]	Naoum GE, Roberts S, Brunelle CL, et al. Quantifying the impact of axillary surgery and nodal irradiation on breast cancer-related lymphedema and local tumor control:long-term results from a prospective screening trial[J]. J Clin Oncol, 2020, 38(29):3430-3438. DOI URL
[38]	Liu YF, Liu JE, Zhu Y, et al. Development and validation of a nomogram to predict the risk of breast cancer-related lymphedema among Chinese breast cancer survivors[J]. Support Care Cancer, 2021, 29(9):5435-5445. DOI URL
[39]	于靖, 孟爱凤, 刘腊根, 等. 早期监测和干预对控制乳腺癌术后继发上肢淋巴水肿的效果评价[J]. 实用医药志, 2021, 38(8):746-748.
	Yu J, Meng AF, Liu LG, et al. Evaluation of the effect of early monitoring and intervention on the control of secondary upper limb lymphedema after breast cancer surgery[J]. Prac J Med & Pharm, 2021, 38(8):746-748.
[40]	张诚霖, 李青荷, 吴翠干, 等. 乳腺癌患者自我报告结局评估工具的研究进展[J]. 中华护理杂志, 2021, 56(6):948-951. DOI URL
	Zhang CL, Li QH, Wu CG, et al. Research progress on an assessment tool of patient-reported outcomes for breast cancer patients[J]. Chin J Nurs, 2021, 56(6):948-951. DOI URL
[41]	刘飞, 司龙妹, 王影新, 等. 乳腺癌相关淋巴水肿患者抗阻力训练的证据总结[J]. 中华护理杂志, 2021, 56(5):755-761. DOI URL
	Liu F, Si LM, Wang YX, et al. Evidence summary of resistance training for breast cancer-related lymphedema[J]. Chin J Nurs, 2021, 56(5):755-761. DOI URL