中药外治法治疗乳腺癌术后上肢淋巴水肿Meta分析
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摘要
目的:系统评价中药外治法治疗乳腺癌术后上肢淋巴水肿的疗效与安全性。方法:对5个数据库进行检索,检索时间均为从建库至2017年4月,收集所有中医药治疗乳腺癌术后上肢淋巴水肿的随对照试验(RCT)。两名研究者独立进行文献筛选、资料提取及严格评价的过程。采用Cochrane偏倚风险评估工具对纳入研究进行方法学质量评价。数据分析运用Revman5.1软件。结果:共纳入15篇文献,1076名患者。Meta分析结果显示,中药外治法联合其他治疗方法治疗乳腺癌术后上肢淋巴水肿在淋巴水肿有效率和减轻患肢疼痛方面优于单独使用其他治疗方法(RR=1.37,95%CI:[1.25,1.50],P<0.000 01)、(MD=-0.53,95%CI:[-0.94,-0.12],P=0.11)。上肢周径的分析结果不一致,其中有5项研究的Meta分析结果提示中药外治法联合其他疗法在缩小上肢周径疗效方面优于其他治疗方法。结论:中药外治法治疗乳腺癌术后上肢淋巴水肿可以减轻患者患肢的淋巴水肿程度,并且无明显不良反应。但由于纳入研究的方法学质量不高,该结论有待大样本、高质量的RCT进一步证实。
Objective:To evaluate the efficacy and safety of traditional Chinese medicine external treatment for upper limb lymphedema after breast cancer operation.Methods:Five databases were searched.The search time was from the establishment of the library to April 2017.All the TCM treatments for the treatment of upper extremity lymphedema after breast cancer were collected.Two investigators independently performed the process of literature screening,data extraction,and rigorous evaluation.Methodological quality evaluation of the included studies was performed by using the Cochrane bias risk assessment tool.Data analysis was performed by using Revman 5.1 software.Results:A total of 15 articles were included,with 1076 patients.Meta-analysis suggests that Chinese medicine external treatment combined with other treatments for upper limb lymphedema after breast cancer surgery is superior to other treatments alone in the treatment of lymphedema and reducing limb pain(RR=1.37,95%CI:[1.25,1.50],P<0.000 01),(MD=-0.53,95%CI:[-0.94,-0.12],P=0.11).The analysis results of the upper limb circumference are inconsistent.Among them,the meta-analysis results of 5 studies suggest that the external treatment of traditional Chinese medicine combined with other therapies is superior to other treatment methods in reducing the effect of upper limb circumference.Conclusion:External treatment of Chinese medicine for upper limb lymphedema after breast cancer surgery can reduce the degree of lymphedema in patients with limbs,without obvious adverse reactions.However,due to the low quality of the methodology incorporated into the study,this conclusion is subject to further confirmation by large sample,high quality RCT.
Objective:To evaluate the efficacy and safety of traditional Chinese medicine external treatment for upper limb lymphedema after breast cancer operation.Methods:Five databases were searched.The search time was from the establishment of the library to April 2017.All the TCM treatments for the treatment of upper extremity lymphedema after breast cancer were collected.Two investigators independently performed the process of literature screening,data extraction,and rigorous evaluation.Methodological quality evaluation of the included studies was performed by using the Cochrane bias risk assessment tool.Data analysis was performed by using Revman 5.1 software.Results:A total of 15 articles were included,with 1076 patients.Meta-analysis suggests that Chinese medicine external treatment combined with other treatments for upper limb lymphedema after breast cancer surgery is superior to other treatments alone in the treatment of lymphedema and reducing limb pain(RR=1.37,95%CI:[1.25,1.50],P<0.000 01),(MD=-0.53,95%CI:[-0.94,-0.12],P=0.11).The analysis results of the upper limb circumference are inconsistent.Among them,the meta-analysis results of 5 studies suggest that the external treatment of traditional Chinese medicine combined with other therapies is superior to other treatment methods in reducing the effect of upper limb circumference.Conclusion:External treatment of Chinese medicine for upper limb lymphedema after breast cancer surgery can reduce the degree of lymphedema in patients with limbs,without obvious adverse reactions.However,due to the low quality of the methodology incorporated into the study,this conclusion is subject to further confirmation by large sample,high quality RCT.
引文
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[5]黑东旭.活血通络汤中药熏洗用于乳腺癌术后上肢水肿患者治疗中的临床效果[J].医药前沿,2017,7(2):282-283.
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[8]金宇,杨赶梅,张子理,等.中药热奄包治疗乳腺癌术后上肢淋巴水肿临床研究[J].实用中医药杂志,2015,31(8):774-775.
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[11]王玥姣,贾立群,朱世杰.乳脉通络洗剂治疗乳腺癌相关性上肢淋巴水肿临床观察[J].中日友好医院学报,2014,28(3):171-172.
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[14]李珍,刘永存,钟小玲.双柏散外敷治疗乳腺癌术后上肢淋巴水肿临床观察[J].辽宁中医药大学学报,2009,11(1):86-87.
[15]沈洪,刘静.皮硝外敷联合空气波压力治疗乳腺癌术后上肢水肿的临床观察[J].中西医结合护理(中英文),2016,2(2):7-9.
[16]张双强.乳腺癌术后上肢水肿的中医用药规律及外治法临床疗效观察研究[D].北京:北京中医药大学,2016.
[17]方琛.四子散联合气压疗法治疗乳腺癌相关淋巴水肿的临床研究[D].广州:广州中医药大学,2014.
[18]廖光冲.消水糊外敷治疗乳腺癌术后并发上肢淋巴水肿的临床观察[D].乌鲁木齐:新疆医科大学,2010.
[2]CHEN W,ZHENG R,ZHANG S,et al.Report of cancer incidence and mortality in China,2010[J].Annals of Translational Medicine,2014,2(7):61.
[3]Mclaughlin S A.Lymphedema:separating fact from fiction[J].Oncology,2012,26(26):242-249.
[4]陈闯.通脉消肿散外敷治疗乳腺癌患侧上肢肿胀40例临床观察[J].湖南中医杂志,2013,29(6):44-46.
[5]黑东旭.活血通络汤中药熏洗用于乳腺癌术后上肢水肿患者治疗中的临床效果[J].医药前沿,2017,7(2):282-283.
[6]唐莉,王华中.活血通络汤行中药熏洗在乳腺癌术后上肢水肿患者中的应用[J].实用预防医学,2012,19(2):251-252.
[7]袁吕荣.中药内服外敷治疗乳腺癌术后上肢淋巴水肿30例[J].长春中医药大学学报,2011,27(5):790-791.
[8]金宇,杨赶梅,张子理,等.中药热奄包治疗乳腺癌术后上肢淋巴水肿临床研究[J].实用中医药杂志,2015,31(8):774-775.
[9]李清勤,岳双冰,范中农,等.中药热奄包治疗乳腺癌术后上肢肿胀的疗效观察与护理[J].深圳中西医结合杂志,2013,23(3):185-187.
[10]潘燕卿,唐丽清.四黄散在乳腺癌术后患肢肿胀35例中的应用[J].中国民族民间医药,2016,25(18):64-64.
[11]王玥姣,贾立群,朱世杰.乳脉通络洗剂治疗乳腺癌相关性上肢淋巴水肿临床观察[J].中日友好医院学报,2014,28(3):171-172.
[12]崔梦迪.香附四子散热熨治疗乳腺癌术后上肢水肿的临床研究[D].北京:北京中医药大学,2014.
[13]高磊.温通消肿外敷方治疗乳腺癌术后上肢水肿的随机、双盲、安慰剂平行对照、多中心研究[D].北京:北京中医药大学,2015.
[14]李珍,刘永存,钟小玲.双柏散外敷治疗乳腺癌术后上肢淋巴水肿临床观察[J].辽宁中医药大学学报,2009,11(1):86-87.
[15]沈洪,刘静.皮硝外敷联合空气波压力治疗乳腺癌术后上肢水肿的临床观察[J].中西医结合护理(中英文),2016,2(2):7-9.
[16]张双强.乳腺癌术后上肢水肿的中医用药规律及外治法临床疗效观察研究[D].北京:北京中医药大学,2016.
[17]方琛.四子散联合气压疗法治疗乳腺癌相关淋巴水肿的临床研究[D].广州:广州中医药大学,2014.
[18]廖光冲.消水糊外敷治疗乳腺癌术后并发上肢淋巴水肿的临床观察[D].乌鲁木齐:新疆医科大学,2010.