不同針灸治療方式干預(yù)乳腺癌術(shù)后上肢淋巴水腫效果的網(wǎng)狀Meta分析

【關(guān)鍵詞】乳腺癌；乳腺癌淋巴水腫；針灸；網(wǎng)狀 Meta 分析；有效率；周徑差值【中圖分類號】R737.9【文獻標(biāo)識碼】A DOI：10.12114/j.issn.1007-9572.2024.0181

Effectof Postoperative Upper ExtremityLymphedemaafter Breast Cancer Treated with Different Acupuncture and Moxibustion Therapies：aNetworkMeta-analysis

HE Yun¹ ，F(xiàn)AN Huanfang2， 3， MAPan² ， XU Shaoqing'，YANG ， JIN Mingzhe’，ZHANG Mingrui’，CHEN Jiaqil

1.Hebei UniversityofTraditional ChineseMedicine，Shijiazhuang O5oooo，China

2.TheFirstAfliatedHospitalofHebei UniversityofTraditional Chinese Medicine，Shijiazhuang O5oooo，China

3.Hebei Key Laboratory of Turbidity and Toxicology，Shijiazhuang O5oooo，China

Corresponding author：FAN Huanfang，Profesor/Doctoral supervisor；E-mail：fhf7Ol024@163.com

【Abstract】BackgroundPostoperative upper extremity lymphedema is acommon postoperative complication in breastcancerpatients，which greatlyafectspatientsqualityoflifeandconfidenceintreatment.Currently，westernmedicine haslimitedefectintreatingpostoperativeupperextremitylymphedemaafterbreastcancer，andacupuncturehasbeerefficacy intreatingthisdisease，however，thereisnoresearchonthechoiceofdiferentacupuncture treatment modalities.Objective To compare the eficacyof diferent acupuncture modalitieson upper extremitylymphedema afterbreast cancer surgeryusingreticulated meta-analysis，with aviewtoprovidinganevidence-based basis forthe selectionof clinicaltreatmentoptions. MethodsAcomputerized systematic search of the China national knowledge infrastructure，Wanfang Data，VIP，China BiomedicalLiteratureService，PubMed，Embase，MedlineandCochraneLibrarydatabasesofrandomizedcontroledtrials （RCT）on theinterventionofdifferentacupuncture modalities inpostoperativelymphedema afterbreastcancer wasconducted from the time of database construction to October 31，2023.The literature search was completed independently by two researchers，andtheinitialandre-screening were performedinstrictaccordance with theinclusionandexclusioncriteria. Afterthefinalinclusionoftheliteraturewascategorized，thebasicinformationanddatawereextractedandtheriskof bias was assesed，and the data were analyzed using software such as R 3.6.2 and Stata 14.0. ResultsFourteen papers were finally included，containing atotalof915patients withupper limb lymphedema afterbreastcancersurgery，including 459 casesinthe treatment groupand456cases inthecontrol group.Eleveninterventions were involved，including conventional treatment，ordinary acupuncture，warm acupuncture，milifire acupuncture，western medicine，acupuncture+moxa stick， conventional+abdominal acupuncture，conventional+warmacupuncture，conventional+acupuncture，conventional+guanxi， andconventional+forceful motionacupuncture.Theresultsoftherankingof thecumulativeprobabilityplotareaundertheurve （SUCRA）ofeach interventiononthediferencebetwee theafected-patientsidecircumferentialdiametersshowedthatthe results of routine + abdominal needling（ 100.0% ）gt;milli-fire needling（ 66.4% ）gt;routine + warm needling （ 58.2% ）gt;regular needling（ 19.0% ）gt;routine（ 6.5% ）.The results of SUCRA ranking of each intervention on the total efficiency showed that milli-fire acupuncture（ 90.1% ） gt; ordinary acupuncture（ 71.1% ）gt;routine+force-activated acupuncture（ 67.7% ）gt;warm acupuncture（ 62.1% ）gt;routine + warm acupuncture （ 57.9% ）gt;acupuncture+moxa sticks（ 50.7% ）gt;routine + off-needling （ 48.2% ）gt;routine+needling（ 47.7% ） gt; routine + abdominal needling（ 38.6% ）gt;western medicine （ 9.6% ）gt;routine（ 6.3% ） ConclusionAmongthe11interventions，thecombinedtotaleficiencyandtherankingof thediferencebetweentheffcted healthysidecicumferenceshowedthatmilipedeacupuncture isthebestchoiceforthetreatmentofupperextremitylymphedema after breast cancer surgery，but more high-quality RCTs are needed to confirm this.

【Key words】Breast cancer；Breast cancer lymphedema；Acupuncture；Mesh meta-analysis；Eficient；Diametel difference

乳腺癌作為中國女性高發(fā)的惡性腫瘤，其發(fā)病率和死亡率均呈持續(xù)上升趨勢，并且其2020年全球發(fā)病率居惡性腫瘤之首[1-2]。手術(shù)是早期乳腺癌患者與部分晚期乳腺癌患者的主要治療方法，術(shù)中廣泛的切除和淋巴結(jié)清掃會導(dǎo)致患者術(shù)后上肢血液回流障礙、淋巴管路堵塞，組織液積聚于組織間隙，從而出現(xiàn)上肢淋巴水腫、持續(xù)疼痛、肩關(guān)節(jié)活動受限等多種并發(fā)癥。據(jù)統(tǒng)計，30%～50% 的術(shù)后患者會發(fā)生上肢淋巴水腫，嚴重危害女性的身心健康與生活質(zhì)量[3]。其中年齡、BMI、放化療、乳腺與腋窩的手術(shù)類型、術(shù)后其他并發(fā)癥均為危險因素，早期評估和預(yù)測其發(fā)生風(fēng)險尤為重要，但目前仍缺乏權(quán)威且適于推廣的風(fēng)險預(yù)測模型[4-5]

目前臨床的治療方法主要以保守治療為主，包括運動康復(fù)、繃帶加壓、推拿按摩、空氣壓力波理療等。針灸作為一種安全性高、操作便捷的中醫(yī)特色治法，可通過刺激穴位來疏通肢體經(jīng)絡(luò)，調(diào)節(jié)氣血運行。JIN等［6]通過系統(tǒng)評價證明針灸療法治療乳腺癌術(shù)后上肢淋巴水腫效果確切，其結(jié)果證明傳統(tǒng)針灸療法與西醫(yī)、理療和功能訓(xùn)練相比效果明顯更佳；與物理療法相比，傳統(tǒng)針灸療法在減輕水腫癥狀方面效果更好；此外，該結(jié)果表明，傳統(tǒng)針灸療法在提高乳腺癌術(shù)后淋巴水腫患者的Karnofsky表現(xiàn)得分方面比功能訓(xùn)練和西醫(yī)效果更好。在國內(nèi)，針灸療法也作為一種有效的中醫(yī)防治方法被《乳腺癌術(shù)后淋巴水腫中西醫(yī)結(jié)合診治中國專家共識》［7]推薦應(yīng)用。……