Objective: To observe the clinical efficacy of lidong needling therapy (acupuncture technique combined with therapeutic movement of the body) on upper limb lymphedema after breast cancer surgery in combination with functional exercise.
Methods: A total of 73 patients with postoperative lymphedema of breast cancer in the upper limbs were randomized into an observation group (36 cases) and a control group (37 cases). The routine nursing care and functional exercise were given in the control group, twice a day, for about 10-15 min each time, lasting 8 weeks. On the basis of the treatment as the control group, lidong needling therapy was applied to the acupionts on the affected upper limb, i.e. Jianyu (LI 15), Waiguan (TE 5), Hegu (LI 4) and ashi points (the most obvious swelling sites), as well as to bilateral Yinlingquan (SP 9) and Zusanli (ST 36), etc. The needles were retained for 30 min. While the needles retained, the patients were asked to move the affected shoulder to 90° by the sagittal anteflexion and keep it elevated. Simultaneously, the hand on the affected side was clenched and opened slowly and coordinately. Lidong needling therapy was delivered once every two days, three times weekly for 8 weeks. Before and after treatment, the difference of the circumference between the affected and healthy limbs, the score of visual analogue scale (VAS) for swelling and the score of disability of arm, shoulder and hand (DASH) were compared in the patients of the two groups. The clinical efficacy was evaluated.
Results: After 2, 4, 6 and 8 weeks of treatment, except for the circumference of the area 10 cm below the cubitel crease in the control group, the differences in the circumferences of the rest parts between the affected and healthy limbs were reduced in comparison with those before treatment in the two groups (P<0.01, P<0.05). After 6 weeks of treatment, in the observation group, for the circumference at the level of hand between the thumb and the index finger and that of the wrist, the differences between the affected and healthy limbs was smaller compared with those in the control group (P<0.05). After 8 weeks of treatment, except for the areas 5 cm below and above the cubitel crease, the differences of circumferences between the affected and healthy limbs in the observation group were smaller than those in the control group in the rest parts (P<0.01, P<0.05). After 8 weeks of treatment, the swelling VAS scores were reduced when compared with those before treatment in the two groups (P<0.05), and the score in the observation group was lower than that in the control group (P<0.01). After 4 and 8 weeks of treatment, DASH scores were reduced in comparison with those before treatment in the two groups (P<0.01). The total effective rate of the observation group was 83.3% (30/36), which was higher than that of the control group (35.1%, 13/37, P<0.01).
Conclusion: Lidong needling therapy combined with the functional exercise obtains the satisfactory clinical effect on the upper limb lymphedema after breast cancer surgery. This treatment effectively relieves swelling and improves the upper limb function.
目的：观察力动针结合功能锻炼治疗乳腺癌术后上肢淋巴水肿的临床疗效。方法：将73例乳腺癌术后上肢淋巴水肿患者随机分为观察组（36例）和对照组（37例）。对照组予常规护理和功能锻炼，每次10~15 min，每日2次，共治疗8周。观察组在对照组基础上加用力动针，穴取患侧上肢肩髃、外关、合谷、阿是穴（肿胀最明显部位）及双侧阴陵泉、足三里等，留针30 min。留针过程中，患侧肩关节在矢状面前屈90°维持上举动作，同时配合患侧手指缓慢做握拳、张开动作。隔日针刺1次，每周3次，共治疗8周。比较两组患者治疗前后患侧与健侧肢体周径差值，肿胀视觉模拟量表（VAS）评分及臂、肩、手障碍（DASH）评分，并评定临床疗效。结果：治疗2、4、6、8周后，除对照组肘横纹下10 cm外，两组患者各部位患侧与健侧肢体周径差值均较治疗前减小（P<0.01，P<0.05）；治疗6周后，观察组患者虎口、腕横纹患侧与健侧肢体周径差值小于对照组（P<0.05）；治疗8周后，除肘横纹下5 cm和肘横纹上5 cm，观察组患者其余部位患侧与健侧肢体周径差值均小于对照组（P<0.01，P<0.05）。治疗8周后，两组患者肿胀VAS评分均较治疗前降低（P<0.05），且观察组低于对照组（P<0.01）。治疗4、8周后，两组患者DASH评分均较治疗前降低（P<0.01）。观察组总有效率为83.3%（30/36），高于对照组的35.1%（13/37，P<0.01）。结论：力动针结合功能锻炼治疗乳腺癌术后上肢淋巴水肿临床疗效较好，可有效缓解肿胀，改善上肢功能。.
Keywords: acupuncture; breast cancer; functional exercise; lidong needling; randomized controlled trial; upper limb lymphedema.