| ObjectiveLower extremity lymphoedema is one of the common complications after lymph node dissection for cervical cancer.Patients with lower extremity lymphoedema can have different degrees of lower extremity lymphoedema after operation.Reasonable postoperative nursing and active exercise have a good effect on the prevention of lower extremity lymphoedema.The purpose of this study was to explore the preventive effect of exercise intervention on lower extremity lymphoedema after cervical cancer surgery.MethodsPatients with cervical cancer who underwent surgery in a Grade-A tertiary hospital in Wuxi from January 2017 to June 2018 were randomly divided into the experimental group and the Control group.The Control group was treated with routine intervention,while the experimental group was treated with exercise intervention in addition to routine intervention.For patients in both groups,the circumference of shank and thigh were measured 3 days prior to operation,1 month after operation and 6 months after operation.The changes of lower limb edema(lower limb tissue moisture and extracellular moisture)were detected by multifrequency bioelectrical body composition analyzer.Limb swelling,limb pain,skin sunken,lacking in strength,and limited mobility were also measured 6 months after surgery by filling out and evaluating the gynecological cancer lymphedema questionnaire.Data analysis was carried out by SPSS 19.0 and SAS 9.4 software packages;the median(interquartile range)was used to describe the non-normal distribution quantitative data,and differences between the two groups were compared by the Wilcoxon signed rank sum test of two independent samples;the composition ratios or rates were used to describe the classification data,and the completely randomized χ2 test was used to compare differences between the two groups.Mean ± standard deviation was used to describe the ratio of circumference of shank and thigh and the moisture content of low-extremity tissue and extracellular moisture content of low-extremity of the experimental group and the control group 3 days prior to operation,1 month after surgery,and 6 months after surgery;analysis of variance repeated measured and designed was used to analyze the differences of these factors between the experimental group and the control group,as well as the differences in three points of time:3 days prior to operation,1 month after surgery and 6 months after surgery;complete randomized χ2 test was used to compare lower-extremity lymphedema and occurrence of related symptoms of patients in the two groups 6 months after surgery;the Wilcoxon signed rank sum test was used to compare severity of lymphedema in the lower extremities of patients with cervical cancer in the experimental group and the control group.The test level was bilateral α=0.05.Results1.Basic characteristics of the research object94 patients were divided into the experimental group and the Control group with 47 patients in each group.The average age of patients in both group was 53,and there was no statistic difference in patients’ conditions,including BMI,history of smoking,parity,history of diabetes,pathological types,clinical stage,lymph node metastasis,type of surgery,operation methods,number of lymphadenectomies,and chemotherapy(for all conditions,the difference was P>0.05).the experimental group had a smaller proportion of patients with drinking history compared with the Control group(6.4%versus 27.7%;χ2=7.532,P=0.006),and it had a smaller proportion of patients with hypertension history(12.8%versus 31.9%;χ2=4.967,P=0.026).2.Changes in the circumference of the patient’s shanks and thighs before and after surgeryThere was no difference between the experimental group and the Control group in the circumference of left thigh and right thigh before and after surgery(F=0.44,P=0.508;F=0.66,P=0.419).However,statistical differences were found in the circumference of left thigh and right thigh at three points of time:3 days prior to operation,1 month after surgery and 6 months after surgery(F=37.19,P<0.0001;F=35.86,P<0.0001).Comparing the circumference of left thigh and right thigh 3 days prior to operation with 1 month after surgery and 6 months after surgery in both groups,statistical differences were found(P<0.0001),but there was no significant difference between 6 months after surgery and 1 month after surgery(P>0.05).Differences were found between the experimental group and the Control group in the circumference of left shank and right shank before and after surgery(F=15.22,P=0.0002;F=10.63,P=0.002),more specifically,circumferences were smaller in the experimental group than the Control group.Statistical differences were found at three points of time,namely 3 days prior to operation,1 month after surgery and 6 months after surgery(F=67.30,P<0.0001;F=79.57,P<0.0001);there were statistical differences in circumference of the left shank and the right shank of patients in the experimental group between 1 month after surgery and 3 days prior to operation(P<0.0001),and between 6 months and 1 month after surgery(P<0.001);no statistical difference was found in circumference of the left shank between 6 months after surgery and 3 days before surgery(P=0.430).Statistical differences were found in circumference of the right shank between 6 months after surgery and 3 days prior to operation(P=0.038).For the Control group,statistical differences were found in circumference of the left and the right shank between 1 month after surgery and 3 days prior to operation,and between 6 months after surgery and 3 days prior to operation(P<0.0001);there was also a statistical difference between 6 months after surgery and 1 month after surgery(P<0.0001).3.Changes in the moisture content of low-extremity tissue and extracellular moisture content of low-extremity of patients before and after surgeryDifferences were found between the experimental group and the Control group in changes of the moisture content of low-extremity tissue before and after surgery(F=38.036,P<0.0001),more specifically,the experimental group was lower than the Control group;there were also statistical differences in time(3 days prior to operation,1 month after surgery,and 6 months after surgery)(F=179.132,P<0.0001).Statistic difference was found in the moisture content of low-extremity tissue between the experimental group and the Control group 1 month after surgery,6 months after surgery,and 3 days prior to operation(P<0.0001);there were also statistical differences between 6 months after surgery and 1 month after surgery(P<0.0001).There were significant differences in extracellular moisture between the experimental group and the control group before and after operation(F=807.478,P<0.0001),and the level of the experimental group was lower than that of the control group,and there were also significant differences in time(F≤510.836,P<0.0001).In the experimental group,the extracellular moisture in the control group was significantly different from that in the control group at 1 month,6 months and 3 days prior to operation(P<0.0001),and there were also significant differences at 6 months and 1 month after operation(P<0.0001).4.The incidence of lower-extremity lymphedema within 6 months after surgeryThe incidence of lower extremity lymphedema in patients with cervical cancer in the experimental group and the Control group was 17.0%and 38.3%,respectively,within 6 months after surgery;its difference was statistically significant(χ=5.317,P=0.021).Among them,a total of 15 cases of thigh lymphedema occurred,5 cases(10.6%)were in the experimental group and 10 cases(21.3%)were in the Control group.There was no significant difference in the incidence of thigh lymphedema between the two groups(P>0.05).A total of 16 cases of shank lymphedema occurred,3 cases(6.4%)were in the experimental group and 13 cases(27.7%)were in the Control group.There was statistical difference in the incidence of shank lymphedema between the two groups(P<0.05).A total of 8 cases of lower-extremity lymphedema occurred in the experimental group,all of which were mild edemas.A total of 18 cases occurred in the Control group,11 of which were mild edemas and 7 of which were moderate edemas.Both groups were considered as severe occurrence of lower-extremity lymphedema.There was a statistical difference in the severity of lower-extremity lymphedema between the two groups(P<0.05),more specifically,the experimental group was slighter than the Control group.5.The incidence of complications related to lower-extremity lymphedema within 6 months after surgeryIn the Control group,the incidence of lower-extremity lymphedema-related complications with 6 months after surgery from high to low were lacking in strength(57.4%),skin sunken(44.7%),limb pain(34.0%),limb swelling(29.8%),and limited mobility(10.6%).Complications in the experimental group,by contrast,has lower incidence of 29.8%,19.1%,14.9%,4.3%,and 2.1%,respectively.The incidence of complications between these two groups was statistically different,except for limited mobility(P<0.05).ConclusionsExercise intervention reduced the incidence of postoperative lymphedema in patients with cervical cancer,and effectively reduced moderate and severe lymphedema;exercise intervention has obvious intervention effect mainly in the circumference of shank,lower extremity tissue level and lower extremity extracellular level;it can effectively reduce the incidence of edema-related complications in patients with cervical cancer 6 months after surgery,including lacking of strength,skin sunkun,limb pain and limb swelling.Results of this study indicate that exercise intervention has a positive effect on preventing lower-extremity lymphedema after cervical cancer surgery. |
PDF Full Text Request