组织工程与重建外科杂志

组织工程与重建外科杂志 ›› 2022, Vol. 18 ›› Issue (3): 242-.

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妇科相关肿瘤术后下肢淋巴水肿合并会阴部水肿的综合治疗初探

  

  • 出版日期:2022-06-01 发布日期:2022-07-11

Preliminary study on the comprehensive treatment of lowerextremity lymphedema complicated with perineal lymphedema

after gynecology related tumors　

  • Online:2022-06-01 Published:2022-07-11

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摘要： 目的　比较分析妇科肿瘤术后下肢淋巴水肿合并会阴部水肿患者采用不同方案治疗的临床效果。方法　2019年11月至2021年6月，接受治疗的妇科肿瘤术后下肢淋巴水肿合并会阴部水肿的患者32例，进行4周治疗。随机分成A、B、C、D组，每组8例。A组采用手法淋巴引流综合消肿治疗（Complex decongestive therapy，CDT）加压力短裤的方式进行治疗；B组采用间歇充气加压仪（Intermittent pneumatic compression，IPC）加压力短裤的方式进行治疗；C组采用CDT加IPC加压力短裤的方式进行治疗；D组采用CDT加IPC加压力短裤及会阴部绷带包扎的方式进行治疗。比较4组患者治疗前后下肢节段水分、下肢周径、腰围、会阴局部水肿程度和分级、阴唇的宽度，以及治疗前后患者的主观感觉。结果　D组患者治疗后肢体节段水分、腰围、阴唇的宽度、会阴水肿分级改善程度优于另外３组，与A、B组差异有统计学意义（P＜0.05），D组的各项指标优于C组。肢体周径、会阴局部水肿程度变化各指标组内比较治疗前后均下降（P＜0.05）。C、D组患者主观感受明显优于A、B组（P＜0.05）。结论　对妇科相关肿瘤术后下肢淋巴水肿合并会阴部水肿患者，采用CDT加IPC加压力短裤及会阴部绷带包扎方式进行治疗，患肢水分、周径显著下降，腰围减小，会阴水肿程度、分级和阴唇宽度显著恢复，患者主观感觉改善明显，无明显不良反应发生，该综合治疗方法值得临床推广应用。

关键词: 淋巴水肿, 　间歇充气加压仪, 　综合消肿治疗, 　会阴水肿

Abstract: 　Objective　To compare and analyze the clinical effects of different approaches in patients with lymphedema of lower extremity combined with perineal edema after gynecological tumor operation. Methods　From November 2019 to June 2021, 32 cases of gynecological tumor patients who were diagnosed with lymphedema of lower limbs combined with perineal edema after surgery were selected for 4-week treatment. The patients were randomly divided into groups A, B, C and D, with 8 cases in each group. Group A was treated with complex decongestive therapy (CDT) plus pressure shorts. Group B was treated with intermittent pneumatic compression (IPC) and pressure shorts. Group C was treated with CDT plus IPC and pressure shorts. Group D was treated with CDT plus IPC plus pressure shorts and perineum bandage. The water content, circumference of lower limb segments, waist circumference, degree of local perineal edema, grade of perineal edema, labia width and subjective feeling of patients were compared between the 4 groups before and after treatment. Results　The improvement degree of hindlimb segmental moisture, waist circumference, labial width and perineal edema grade in group D was better than that in group A, B and C, and the difference was statistically significant compared with group A and B (P<0.05). The indexes of group D were better than those of group C. There were no significant differences in limb circumference diameter and local perineum edema among the four groups (P>0.05). The subjective feeling of patients in group C and D was better than that in group A and B, and the difference was statistically significant (P<0.05). Conclusion　Using CDT plus IPC plus pressure shorts and perineal bandage to treat the patients with lymphedema of lower extremity combined with perineal edema after gynecological related tumors, the affected limb moisture and circumference can be significantly reduced, waist circumference can be decreased, the degree of perineum edema, grade and labial width can be significantly restored, the subjective sensation of patients can be improved, no obvious adverse reactions occurs. It is worthy of clinical application.

Key words: Lymphedema, 　Intermittent pneumatic compression, 　Complex decongestive therapy, 　Perineal edema