目的 探討地奧司明聯(lián)合氫氯噻嗪治療乳腺癌術后上肢淋巴水腫的臨床療效。方法 選擇2017年1月—2018年12月在德陽市人民醫(yī)院診治的乳腺癌術后上肢淋巴水腫患者172例作為研究對象，依據(jù)不同的治療方法將患者分為對照組（72例）和觀察組（100例）。對照組口服氫氯噻嗪片，50 mg/次，2次/d。觀察組在對照組治療的基礎上口服地奧司明片，0.9 g/次，2次/d。2周為1療程，兩組患者均進行2個療程的觀察治療。觀察兩組患者的臨床療效，同時比較兩組的淋巴水腫與乳腺癌問卷（LBCQ）評分、手臂5點周徑、肩關節(jié)活動優(yōu)良率。結果 治療后，觀察組與對照組的治療總有效率分別為95.0%和70.8%，兩組比較差異具有統(tǒng)計學意義（P<0.05）。治療后，兩組的LBCQ評分均顯著低于治療前（P<0.05），且觀察組評分也顯著低于對照組（P<0.05）。觀察組治療前后患側上肢5點周徑對比差異都無統(tǒng)計學意義，對照組治療后虎口掌徑與腕橫紋周徑顯著增加（P<0.05）。治療后，觀察組的肩關節(jié)活動優(yōu)良率為99.0%，顯著高于對照組的88.9%（P<0.05）。結論 地奧司明聯(lián)合氫氯噻嗪治療乳腺癌術后上肢淋巴水腫不會改變患側上肢5點周徑，可促進緩解臨床癥狀，改善肩關節(jié)功能，從而提高治療效果。

Objective To investigate the effects of diosmin combined with hydrochlorothiazide in treatment of upper limb lymphedema after breast cancer surgery. Methods Patients (172 cases) with upper limb lymphedema after breast cancer surgery from January 2017 to December 2018 in People's Hospital of Deyang City were selected. And patients were divided into control group (72 cases) and observation group (100 cases), accorded to different treatment methods. Patients in the control group were po administered with Hydrochlorothiazide Tablets, 50 mg/time, twice daily. Patients in the observation group were po administered with Diosmin Tablets on the basis of control group, 0.9 g/time, twice daily. 2 weeks was a course of treatment, and patients in two groups were treated for 2 courses. The clinical efficacy in two groups were observed, and LBCQ score, 5 point peri-diameter of upper limb, and excellent and good rate of shoulder joint movement were compared. Results After treatment, the total effective rates in the observation group and the control group were 95.0% and 70.8%, respectively, with statistically significant differences between two groups (P<0.05). After treatment, the LBCQ score in two groups was significantly decreased (P<0.05), and the score in the observation group was significantly lower than that in the control group (P<0.05). In the observation group, there was no statistically significant difference in the 5 point peri-diameter of upper limb of the affected side before and after treatment. After treatment, the diameter of palm width and the circumferential diameter of the wrist in the control group were significantly increased (P<0.05). After treatment, the excellent and good rate of shoulder joint movement in the observation group was 99.0%, which was significantly higher than 88.9% in the control group (P<0.05). Conclusion Diosmin combined with hydrochlorothiazide in treatment of upper limb lymphedema after breast cancer surgery will not change the 5-point circumference diameter of the affected side of upper limb, which can relief the clinical symptoms, improve the shoulder joint function, and thus improve the treatment effect.

R984

中國醫(yī)藥教育協(xié)會基金項目（［2016］001）