| ObjectiveThrough the literature analysis of the clinical randomized controlled trials of acupuncture in the treatment of limb secondary lymphedema,the clinical efficacy and safety of acupuncture in the treatment of limb secondary lymphedema were preliminarily and systematically evaluated.Through further clinical randomized controlled trials of micro-acupuncture collateral drainage method,the clinical efficacy and safety of micro-acupuncture collateral drainage therapy in the treatment of limb secondary lymphedema were evaluated.To explore the therapeutic advantages of micro-acupuncture collateral drainage method in the treatment of limb secondary lymphedema,and to provide evidence-based medical support for clinical and scientific research.MethodsStudy 1:The Chinese and English literatures of randomized controlled trials of acupuncture in the treatment of limb secondary lymphedema were searched in electronic databases such as CNKI,Wangfang,VIP,SinoMed,PubMed,Embase,MEDLINE,Cochrane Library and Web of Science.The search time limit was from January 1,2012 to January 15,2023.Evaluators independently screened the literature,extracted the data and evaluated the risk of bias of the included studies.RevMan 5.4 software was used for Meta-analysis of relevant evaluation indicators(effective rate,circumference difference,VAS pain score,shoulder joint activity,etc.).Study 2:A randomized controlled trial was conducted to randomly divide 60 patients with secondary lymphedema of lower limbs into two groups.The treatment group was treated with micro-acupuncture and collateral drainage,once a week,20 minutes each time,for a total of 8 weeks.The control group was given comprehensive detumescence therapy(CDT),in which lymphatic drainage was performed once a week,30 minutes each time,and elastic socks were worn 5 days a week,6-10 hours a day.At the same time,physical exercise and skin care were performed daily for a total of 8 weeks.The TCM symptom scores,lower limb circumference(average circumference of the affected limb,foot heart,ankle,calf midpoint,10 cm below the inferior margin of the patella and 10 cm above the superior margin of the patella),quality of life scores and clinical safety of patients with lower limb lymphedema were recorded before and after treatment.SPSS25.0 statistical analysis was used to evaluate the clinical efficacy from multiple angles.ResultsStudy 1A total of 10 randomized controlled trials were included in this study to determine 578 patients.The results of Meta-analysis showed that 4 studies showed that acupuncture treatment could improve the effective rate of patients with limb secondary lymphedema(OR=4.49,95%CI[2.26,8.94],P<0.0001),and 5 studies showed that acupuncture treatment could reduce the circumference difference between the affected and healthy sides(MD=-1.21,95%CI[-1.66,-0.75],P<0.00001).Five assessments found that acupuncture effectively improved the pain score of the affected limb of lymphedema(MD=-1.23,95%CI[-1.54,-0.92],P<0.00001);two items proved that acupuncture treatment was effective in improving the range of motion of the shoulder joint of the affected limb(MD=2.06,95%CI[0.76,3.35],P=0.002),especially in the extension(MD=6.77,95%CI=[2.81,10.73],P=0.0008),and adduction(MD=4.17,95%CI=[1.02,7.32],P=0.01).There was no statistical difference between the acupuncture group and other treatment groups in the improvement of other shoulder joint motion directions(flexion,abduction,internal rotation and external rotation).Anteflexion(MD=0.18,95%CI[-3.14,3.76],P=0.92),abduction(MD=1.25,95%CI[-1.36,3.86],P=0.35),internal rotation(MD=2.57,95%CI[-3.58,8.72],P=0.41)and external rotation(MD=2.29,95%CI[-2.13,6.71],P=0.31);5 studies described acupuncture treatment of lymphedema without infection and other serious.Study 21.Baseline level:two groups of patients in age,sex,body mass index,disease location,course of disease,disease stage,combined disease and TCM symptom score,lower limb circumference,lower limb lymphedema patients quality of life and other efficacy evaluation data,the statistical analysis of the difference was not statistically significant(P>0.05).2.Improvement of TCM symptom score before and after treatment of affected limbs:1 After treatment,the total score of TCM symptoms,TCM symptom score and TCM sign score of affected limbs in the two groups were lower than those before treatment,and the difference was statistically significant(P<0.001).The treatment group was better than the control group,and the difference was statistically significant(P<0.01).The treatment group was better than the control group(P<0.01).There was no significant difference between the two groups(P>0.05).3.Improvement of the circumference of the affected limb before and after treatment:1 After treatment,the average circumference of the affected limb,the circumference of the foot,the circumference of the ankle,the circumference of the midpoint of the calf,the circumference of 10 cm below the lower edge of the patella,and the circumference of 10 cm above the upper edge of the patella were smaller than those before treatment,and the difference was statistically significant(P<0.01).2 There was no significant difference between the two groups in the average circumference of the affected limb,the circumference of the foot,the circumference of the ankle,the circumference of the midpoint of the calf,the circumference of 10 cm below the lower edge of the patella,and the circumference of 10 cm above the upper edge of the patella(P>0.05).3 There was no significant difference in the circumference difference between the treatment group and the control group at 10 cm below the lower edge of the patella(P>0.05).The average circumference difference of the affected limb and the circumference difference at 10 cm above the upper edge of the ankle and patella were better in the control group than in the treatment group(P<0.05).4.Main efficacy index-clinical effective rate of TCM symptoms:After 8 weeks of treatment,26 cases were effective in the treatment group,1 case was ineffective,the effective rate was 96.3%,19 cases were effective in the control group,7 cases were ineffective,and the effective rate was 83.0%.5.Quality of life score of patients with lower extremity lymphedema:1 The quality of life scores of the two groups after treatment were lower than those before treatment,and the difference was statistically significant(P<0.001).The treatment group was better than the control group,and the difference was statistically significant(P<0.05).6.Clinical safety:During the treatment,no adverse events such as infection and skin allergy were found in both groups.ConclusionStudy 1:Based on the current systematic evaluation and Meta-analysis results,acupuncture treatment of secondary lymphedema has improved clinical efficiency,reduced the circumference difference between the affected and healthy sides,reduced the VAS pain score of the affected limbs,improved limb joint mobility and better clinical safety.Acupuncture treatment of secondary lymphedema is safe and effective.Study 2:Micro-acupuncture collateral drainage therapy can significantly improve the clinical efficiency of TCM symptoms,reduce the TCM symptom score of the affected limb,reduce the circumference of the affected limb,improve the quality of life of patients with lower limb lymph,and no adverse events such as infection occur.Micro-acupuncture collateral drainage is a safe and effective treatment for secondary lymphedema of lower limbs. |
PDF Full Text Request