Risk Factors Analysis And Effect Observation Of Acupoint Electrical Stimulation Combined With Complex Decongestive Therapy Of Breast Cancer Related Lymphedema

Objective Investigate the incidence and risk factors of breast cancer related lymphedema(BCRL)after breast cancer surgery,observe the therapeutic effect of acupoint electrical stimulation combined with complex decongestive therapy(CDT)in the treatment of BCRL after breast cancer surgery,and explore a new treatment method of BCRL.Methods 1.Total 246 female patients diagnosed with unilateral breast cancer and underwent surgery in Shanghai Changhai hospital from August 2015 to August 2017 were selected.The BCRL were assessed by questionnaire or telephone follow-up,and the severity of the BCRL was determined by the perception of self-symptom in both hands,forearms and upper arms.Factors that might be related to upper limb lymphedema,such as body mass index(BMI),age of onset,tumor size,number of axillary lymph node positive lymph nodes,chemotherapy,radiotherapy,history of endocrine treatment,accompanied by hypertension,diabetes and other diseases,were analyzed.2.According to the inclusion and exclusion criteria,60 cases of BCRL were randomly divided into the experimental group and the control group,30 cases each.The experimental group was treated with acupoint electrical stimulation combined with complex decongestive therapy.The control group only received complex decongestive therapy treatment,the two groups were treated once a day and 5 times a week,and the efficacy was evaluated after 2 weeks and 4 weeks.The International Lymphatic Society recommends a complex decongestive therapy as an effective treatment for lymphedema,including manual lymphatic drainage,exercise therapy,pressure therapy,and skin care.Electrical stimulation at low frequency acupoints was used,Mainly select the acupoints on the arm,Jian Yu,Jian Liao,Chi Ze,Qu Chi,He Gu,Wai Guan,the distant acupoints Yang Lingquan,Yin Lingquan,Zu Sanli,San Yinjiao.Adhesive patches were attached to the accurate acupoints,and the current was adjusted to cause the obvious sense of stimulation at the acupoints.The clinical symptoms of patients after treatment were evaluated by evaluators,limb circumferences,bioelectrical impedance analysis,grip strength,pain index,and quality of life were assessed.Results 1.The incidence of upper extremity lymphedema in 246 breast cancer patients was 19.11%(47/246),and multivariate analysis showed that hypertension(OR=11.868),chemotherapy(OR=6.669),radiotherapy(OR=3.408),and axillary lymph node metastasis(OR=3.838)all increased the risk of BCRL.2.Limb circumferences: the mean limb circumference of the control group and the experimental group after treatment decreased significantly,with statistically significant difference(P < 0.05).The analysis results showed that the difference of limb circumference mean between the two groups was statistically significant(F=4.925,P < 0.05).After treatment,the limb circumference of the patients gradually decreases,and there is an interactive effect between the treatment methods and the treatment times.With the extension of the treatment time,the limb circumference of the control group and the experimental group decreases at a different range,and the decline range and speed of the experimental group is significantly greater than the control group.3.Extracellular water ratio: the results showed that there was an interaction between the treatment methods and measurement times in the two groups(F=4.096,P=0.029);Within the same method group,there were significant differences in different measurement times(F=38.583,P < 0.05).After treatment,the extracellular water ratio of the affected limb in the two groups gradually decreased,and there was an interactive effect between the treatment methods and the treatment times.With the extension of the treatment time,the affected limb in the control group and the experimental group decreased at a different extent,and the decline rate in the experimental group was significantly greater than that in the control group.4.VAS pain score: after treatment,the pain index decreased in the two groups,with statistically significant results;There was no significant difference in the degree of pain reduction between the two groups(p>0.05).5.Grip strength: After treatment,the grip strength of the two groups increased,and the results were statistically significant.The comparison of grip strength between the two groups was statistically significant(P < 0.05).6.Quality of life: there were three parts in FACT-B: physiological status,functional status and appendix attention,and the difference between the two groups before and after treatment was statistically significant(P < 0.05).Conclusion Breast cancer related lymphedema is one of the serious postoperative complications.Patients with hypertension,axillary lymph node metastasis and postoperative chemotherapy and radiotherapy,health education and preventive measures should be actively conducted to avoid lymphedema.Acupoint electrical stimulation combined with complex decongestive therapy is applied in the treatment of lymphedema after breast cancer surgery,with definite effect,which can not only reduce the symptoms of lymphedema,but also significantly improve the pain symptoms and quality of life,which can be popularized in clinical application.