乳癌術後淋巴水腫的物理治療－實證醫學報告

Physical Therapy for Breast Cancer-related Lymphedema: Evidence-Based Practice

楊靜蘭(Jing-Lan Yang) ； 曹昭懿(Jau-Yih Tsauo)

《物理治療》 31卷5期 (2006/10) Pp. 294-300

摘要

背景及目的：本文目的在於回顧文獻、探討完整之減腫脹物理治療法及其個別治療項目用於治療乳癌術後淋巴水腫病人的實證醫學報告。方法：搜尋MEDLINE、CINAHL、EBMR等資料庫。選取文章的研究類型包含了綜合分析、系統性回顧及隨機控制研究；語文為英文；文章須有全文。結果：到2006年6月9日為止，共有1篇綜合分析、1篇系統性回顧、8篇隨機控制研究及多篇的非隨機控制研究。對於乳癌相關的淋巴水腫，層級I的證據顯示(l)壓縮衣物加上運動及皮膚照護的衛教之外，另外再加上徒手淋巴引流的治療未能顯著降低病人的肢體體積；(2)相較於自我按摩，徒手淋巴引流能顯著降低多餘肢體體積；(3)使用多層次繃帶後再加上壓縮衣物組的療效較只有壓縮衣物來得好。層級Ⅱ的證據顯示壓縮衣物再加上電刺激的療效並未比只使用壓縮衣物好。結論：目前臨床上所使用的治療模式，大都根據專家建議及個別治療師的臨床經驗。未來需要更多設計完善的隨機控制研究以了解完整之減腫脹物理治療法應如何執行及其個別治療項目當中何者爲較有效的治療方式。

關鍵字

淋巴水腫 ； 實證醫學 ； 完整之減腫脹物理治療 ； 乳癌

並列摘要

Complete decongestive physiotherapy (CUP) is a treatment technique specifically for patients with lymphedema It includes manual lymph drainage, compression therapy, exercise and skin care. The purpose of this article was to review literature related to effectiveness of CDP and its individual items in treating breast cancer patients with lymphedema. The author searched MEDLINE, CINAHL and EBMR: Cochrane Database of Systemic Review. Two review articles and eight randomized controlled trials were found. Grade A evidence showed that (1) An addition of manual lymph drainage to the standard treatment of compression garment, exercise, and skin care did not have larger effect for volume reduction; (2) manual lymph drainage was more effective to reduce excess limb volume in comparison with self-massage; (3) the treatment effect of using multiple layer bandage plus compression garment was better than using compression garment alone. Grade B evidence showed that the usage of compression garments plus electrical stimulation was no better than using compression garment alone. Current evidences for treating patients with lymphedema seemed to have limitation on study size and good quality. More randomized controlled studies are needed in the future for understanding how to implement CDP for better treatment results.

並列關鍵字

Lymphedema ； Evidence-based medicine ； Complete decongestive physiotherapy ； Breast neoplasm