Выпуск 23-3, 2024

Обзорная статья

https://doi.org/10.38025/2078-1962-2024-23-3-40-51

Новые немедикаментозные технологии при лимфедеме, связанной с раком груди: обзор литератур

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1 ORCIDАпханова Т.В., 1 ORCIDКончугова Т.В., 1 ORCIDКульчицкая Д.Б., 1 ORCIDЮрова О.В., 1 ORCIDСтяжкина Е.М., 1 ORCIDМарфина Т.В., 1 ORCIDАгасаров Л.Г., 1 ORCIDВасильева В.А., 1 ORCIDБерезкина Е.С.

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


РЕЗЮМЕ

ВВЕДЕНИЕ. Лимфедема, связанная с раком груди (ЛСРГ) (Breast Cancer-Related Lymphedema, BCRL), — одно из наиболее частых осложнений после радикального лечения рака молочной железы (РМЖ). Особенностью течения ЛСРГ на поздних стадиях является резистентность к лечению и трудности контроля за отеками. В настоящее время отсутствуют молекулярные терапевтические мишени, фармакологическое воздействие на которые могло бы предотвратить возникновение отеков, в связи с чем необходимо изучить эффективность немедикаментозных технологий.

ЦЕЛЬ. Изучение эффективности немедикаментозных технологий при ЛРСГ для разработки рекомендаций по их практическому применению на основе анализа систематических обзоров и метаанализов рандомизированных контролируемых исследований (РКИ).

МАТЕРИАЛЫ И МЕТОДЫ. Поиск проводился в базе данных по доказательной физиотерапии (PEDro) по ключевым словам: «лимфедема», «верхние конечности», «рак груди» с 2002 по 2024 г. Всего на март 2024 г. было отобрано 203 источника, из которых 54 составили систематические обзоры, 2 — Кокрановские обзоры, 1 — Клинические рекомендации (американского общества клинической онкологии), а также 146 РКИ (71,92 %).

РЕЗУЛЬТАТЫ И ОБСУЖДЕНИЕ. В многочисленных исследованиях установлено, что применение ранних послеоперационных физических упражнений с постепенным расширением нагрузки под наблюдением инструктора по лечебной физкультуре (ЛФК) у пациентов с риском развития ЛСРГ — безопасный и эффективный метод реабилитации. Эффективность раннего профилактического применения мануального лимфодренажа (МЛД), по данным 4 РКИ, показана в Кокрановском обзоре, при этом клиническая эффективность раннего профилактического назначения МЛД, влияющая на риск ЛСРГ, все еще остается недостаточно доказанной. Напротив, доказано, что профилактическое использование компрессионных рукавов по сравнению с контрольной группой уменьшило и отсрочило возникновение отеков рук у женщин с высоким риском развития ЛСРГ в течение первого года после операции по поводу РМЖ. Также проведенные исследования подтвердили эффективность применения модели раннего проспективного наблюдения с использованием биоимпедансной спектроскопии для раннего выявления и незамедлительного лечения ЛСРГ. Показано, что для значительного уменьшения объема конечности при ЛСРГ необходимо назначение интенсивной фазы комплексной противоотечной терапии (КПТ) в течение не менее 3 недель. Также доказана эффективность применения стандартного или усовершенствованного устройства переменной пневматической компрессии на этапах реабилитации, в том числе в домашних условиях.

ЗАКЛЮЧЕНИЕ. Для снижения риска развития и прогрессирования ЛСРГ до тяжелых клинических стадий лимфатического отека должны применяться современные методики ЛФК для повышения физической активности с целью контроля веса, активно использоваться обучающие методики по самомассажу, самостоятельному наложению компрессионных бандажей. «Золотым стандартом» консервативного лечения ЛСРГ остается КПТ, основой которой является МЛД. Вместе с этим оправдано более широкое применение и разработка новых методик аппаратного лимфодренажа, имитирующих МЛД — высокоресурсный и затратный метод лечения при ЛСРГ. Для подтверждения клинической эффективности усовершенствованной аппаратной пневмокомпрессии требуется проведение дополнительных РКИ с оценкой отдаленных результатов лечения.


КЛЮЧЕВЫЕ СЛОВА: лимфедема руки, рак молочной железы, реабилитация, мануальный лимфодренаж, переменная пневмокомпрессия

ИСТОЧНИК ФИНАНСИРОВАНИЯ: Данное исследование не было поддержано никакими внешними источниками финансирования.

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

ДЛЯ ЦИТИРОВАНИЯ:

Апханова  Т.В., Кончугова  Т.В., Кульчицкая  Д.Б., Юрова  О.В., Стяжкина  Е.М., Марфина  Т.В., Агасаров Л.Г., Васильева В.А., Березкина Е.С. Новые немедикаментозные технологии при лимфедеме, связанной с раком груди: обзор литературы. Вестник восстановительной медицины. 2024; 23(3):40-51. https://doi.org/10.38025/2078-1962-2024-23-3-40-51 [Apkhanova T.V., Konchugova T.V., Kulchitskaya D.B., Yurova O.V., Styazhkina E.M., Marfina T.V., Agasarov L.G., Vasileva V.A., Berezkina E.S. New Non-Drug Technologies for Lymphedema Associated with Breast Cancer: a Review. Bulletin of Rehabilitation Medicine. 2024; 23(3):40-51. https://doi.org/10.38025/2078-1962-2024-23-3-40-51 (In Russ.).]

ДЛЯ КОРРЕСПОНДЕНЦИИ:

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


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