肌內效貼布是否可取代治療乳癌術後淋巴水腫之減腫脹淋巴治療法中的繃帶？

Abstract

減腫脹淋巴治療法是普遍被接受用以治療乳癌術後淋巴水腫的治療技術，然而受限 於台灣濕熱的氣候，其中的繃帶治療之實用性較低。近年來，日本研發的肌內效貼布宣稱可以增進淋巴循環，但截至目前沒有相關的研究。本研究目的期能探討減腫脹淋巴治療法、以肌內效貼布取代繃帶的修正式減腫脹淋巴治療法之療效，並且加以比較。本研究招收單側乳癌術後淋巴水腫3個月以上的病患，隨機分配至傳統減腫脹淋巴治療法（傳統繃帶組）與修正式減腫脹淋巴治療法（修正貼布組）兩組，兩組均接受一個月的控制期，與一個月的介入期，並在控制期前後與介入期後接受評估。評估項目包括上肢腫脹程度、上肢水組成、纖維化嚴重度、與淋巴水腫相關症狀、上肢功能、生活品質與受試者使用繃帶或貼布的反應。介入期的治療的內容包括皮膚照護衛教、徒手淋巴引流30分鐘、淋巴循環器1小時與自我按摩與運動20分鐘。在自我運動與按摩前，傳統繃帶組包紮短伸縮性繃帶；修正貼布組貼紮肌內效貼布。上述治療，2小時/次，5次/週，共計一個月。本研究採獨立兩樣本t檢定(independent two samples t-test)/獨立樣本U檢定(Mann-Whitney U test)/ 卡方檢定(chi square)檢定傳統繃帶組與修正貼布組兩組間在各連續變項的干擾因子、初評各個依變項與兩組進步總量在兩組間是否有差異。單因子重複測試(one way repeated measure)/ Friedman test檢定兩組病患組內之療效。結果顯示，傳統繃帶組與修正貼布組在介入期間在腫脹程度、上肢水組成之不平衡與症狀減少均達顯著差異(p<0.05)；傳統繃帶組在控制期上臂背側纖維化程度有統計上顯著之增加；修正貼布組在介入期生活品質之角色功能有統計上顯著之進步。兩組在控制期與介入期，上肢功能都沒有顯著變化。組間比較的結果顯示，除了纖維化嚴重度度在上臂背側與前臂腹側以傳統繃帶組減少較多外，所有的變項兩組間沒有顯著差異。貼布的接受度普遍較繃帶為佳，使用時間較長、受試者覺得困難度較低、較方便並且較舒適(p<0.05)。本研究顯示貼布可以提供無法耐受長時間使用繃帶的病患另一個選擇，建議後續研究應該要更進一步瞭解肌內效貼布的作用機轉。

Decongestive lymphatic therapy (DLT) is a common management for lymphedema. Patients have poor compliance in using short-stretch bandage and compression garments due to the humid climate in Taiwan. Applying kinesio-tape (K-tape) becomes a new choice in the field of physical therapy. The inventor Dr. Kase claimed that the K-tape can improve circulation and remove congestion. However, there is insufficient evidence to show the clinical effects of K-tape. The purpose of this study is to investigate the treatment effect of traditional DLT and modified DLT which replace bandage with K-tape. Then, compare the treatment effects between these two treatments. A randomized control study was executed. Patients with unilateral breast-cancer-related lymphedema who have suffered lymphedema for at least 3 months were randomly grouped into DLT group (bandage group) and modified DLT group (taping group).Each subject went through 4 weeks of control period and 4 weeks of intervention period. The evaluation was executed before and after the control period and after the intervention period. The evaluation items included physical therapy assessment, the severity of swelling, water composition of the upper extremity, severity of fibrosis, lymphedema related symptoms, the upper extremity function and quality of life. Subjects in each group received treatments including skin care, 30-minute manual lymphatic drainage, 1- hour pneumatic compression therapy and 20-minute exercise during the intervention period; patients in the bandage group received additional bandage treatment; patients in the taping group received additional K-tape treatment. Each group was treated 2 hours/session, 5 sessions/week with the entire course taking 4 weeks. To analyze the differences of all the confounding factors, outcome variables at baseline and total improvement between groups were compared with independent two samples t-test/ Mann-Whitney U test/ chi square test. Treatment effect within group is analyzed by one way repeated measure/ Friedman test. The results showed that both groups had significant reduction (p<0.05) in severity of swelling, imbalance of water composition, and lymphedema related symptoms during the intervention period; bandage group had significant increase of fibrosis over dorsal area of the upper arm during the control period; taping group had improvement in role function which is one of the items in quality of life measurement during the intervenetion period. The upper extremity function score had no significant change during the control and intervention period in both groups. There was no significant difference between groups except the severity of fibrosis. The reduction of fibrosis in the bandage group is more than the taping group in dorsal area of the upper arm and ventral area of the forearm. The acceptance of Kinesio tape is better than bandage including longer using time, less difficulty, more comfortable and convenient (p<0.05). The study results suggested that Kinesio taping could replace the bandage in DLT. Further study should investigate the rationale of the Kinesio Taping.