Выпуск 23-1, 2024

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https://doi.org/10.38025/2078-1962-2024-23-1-66-76

Актуальные аспекты медицинской реабилитации пациентов с лимфедемой конечностей, связанной с лечением рака. Обзор литературы

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1 ORCID Кончугова Т.В., 1 ORCID Апханова Т.В.,1 ORCID Кульчицкая Д.Б., 1 ORCID Юрова О.В., 1 ORCID Агасаров Л.Г., 1 ORCID Марфина Т.В.

1ФГБУ «Национальный медицинский исследовательский центр реабилитации и курортологии» Минздрава России, Москва, Россия


РЕЗЮМЕ

ВВЕДЕНИЕ. За последние десятилетия в развитых странах и в Российской Федерации наблюдается рост числа пациентов c вторичной лимфедемой, перенесших оперативное лечение с диссекцией регионарных лимфатических узлов и лучевой терапией по поводу различных форм гинекологического рака у женщин и рака простаты у мужчин, а также рака молочной железы.

ЦЕЛЬ. Поиск и анализ результатов ранее опубликованных рандомизированных контролируемых исследований (РКИ) эффективности различных немедикаментозных методов реабилитации у пациентов с лимфедемой конечностей, перенесших радикальное лечение по поводу рака различной локализации.

МАТЕРИАЛЫ И МЕТОДЫ. Был проведен поиск и изучены публикации в международных научных рецензируемых изданиях (база PEDro), посвященные медицинской реабилитации при лимфедеме, связанной с лечением рака (ЛСЛР), за период с 1996 г. по декабрь 2023 г., по ключевым словам «lymphedema», «rehabilitation». 145 РКИ посвящено медицинской реабилитации и консервативному лечению ЛСЛР.

ОБСУЖДЕНИЕ. Коррекция образа жизни, психосоциальные вмешательства рекомендуются для улучшения качества жизни пациентов. В проведенных исследованиях установлено, что ранняя активизация, различные физические упражнения при медленном увеличении нагрузок под наблюдением врача ЛФК являются безопасными и способствуют увеличению выносливости, силы и диапазона движений в конечности с лимфатическим отеком. Доказана клиническая эффективность лечебной гимнастики в бассейне, проявляющаяся в уменьшении отеков у пациентов с ЛСЛР. Подтверждена эффективность компрессионных изделий с технологией Velcro, альтернативных жестким низкорастяжимым бандажам у пациентов с ЛСЛР. Доказаны противоотечный и противовоспалительный эффекты низкоинтенсивной лазерной терапии и магнитотерапии при реабилитации пациентов с ЛСЛР. Переменная пневмокомпрессия (ППК) рекомендуется в качестве адъювантного метода лечения в дополнение к комплексной противоотечной терапии. Предпочтение должно отдаваться применению технологий усовершенствованных аппаратных лимфодренажных методов, имитирующих ручные мануальные техники.

ЗАКЛЮЧЕНИЕ. Для улучшения физического и социально-психологического функционирования пациентов с ЛСЛР необходим комплексный подход, включающий изменение образа жизни, психологическую коррекцию, компрессионную терапию, современные методики ЛФК, безопасные физиотерапевтические технологии. Проведенные научные исследования свидетельствуют о высокой эффективности применения ручных и аппаратных лимфодренажных методик, при этом применение ППК является более экономичным и доступным, не требует привлечения специалистов, владеющих дорогостоящей методикой мануального лимфодренажа.

КЛЮЧЕВЫЕ СЛОВА: лимфедема конечностей, рак груди, гинекологический рак, переменная пневмокомпрессия, лазе- ротерапия, магнитотерапия, мануальный лимфодренаж

ИСТОЧНИК ФИНАНСИРОВАНИЯ: Авторы заявляют об отсутствии финансирования при проведении исследования.

КОНФЛИКТ ИНТЕРЕСОВ: Авторы декларируют отсутствие явных и потенциальных конфликтов интересов, связанных с публикацией настоящей статьи.

ДЛЯ ЦИТИРОВАНИЯ:

Кончугова Т.В., Апханова Т.В., Кульчицкая Д.Б., Юрова О.В., Агасаров Л.Г., Марфина Т.В. Актуальные аспекты медицинской реабилитации пациентов с лимфедемой конечностей, связанной с лечением рака. Обзор литературы. Вестник восстановительной медицины. 2024; 23(1):66-76. https://doi.org/10.38025/2078-1962-2024-23-1-66-76 [Konchugova T.V., Apkhanova T.V., Kulchitskaya D.B., Yurova O.V., Agasarov L.G., Marfina T.V. Current Aspects of Medical Rehabilitation of Patients with Cancer Related Lymphedema of Extremities: a Narrative Review. Bulletin of Rehabilitation Medicine. 2024; 23(1):66-76. https://doi.org/10.38025/2078-1962-2024-23-1-66-76 (In Russ.).] 

ДЛЯ КОРРЕСПОНДЕНЦИИ:

Апханова Татьяна Валерьевна, E-mail: apkhanovatv@nmicrk.ru


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