[Clinical effects of extracorporeal shock wave combined with complex decongestive therapy in the treatment of lower limb lymphedema after cervical cancer surgery]

Abstract

Objective: To explore the clinical effects of extracorporeal shock wave therapy (ESWT) combined with complex decongestive therapy (CDT) in the treatment of lower limb lymphedema after cervical cancer surgery. Methods: This study was a prospective randomized controlled trial. From April 2023 to December 2024, 64 patients were admitted to the Department of Oncology Rehabilitation of Nan'ao People's Hospital of Dapeng New District of Shenzhen. All patients were female, aged 33-75 years. The patients were divided into control group treated with CDT alone and combined treatment group treated with ESWT and CDT according to the random number table method, with 32 patients in each group. Four patients withdrew in the research process, and 30 patients were included in each group finally. Before treatment and at the end of 4 weeks of treatment (hereinafter referred to as after treatment), the skin stiffness was measured using a portable MyotonPRO device at the superficial projection position of vastus lateralis, vastus medialis, vastus intermedius, medial gastrocnemius, and lateral gastrocnemius to reflect the degree of skin fibrosis of lower limb, the circumferences were measured at the mid-knee, 10 cm and 20 cm above the superior patellar border, and the mid-ankle, 10 cm and 20 cm below the inferior patellar border to reflect the severity degree of edema of lower limb, the life quality was scored using the simplified Chinese version of the lower limb lymphedema functioning, disability, and health questionnaire (Lymph-ICF-LL), and the pain intensity was scored using the visual analogue scale (VAS). The differences of the above indexes were calculated between before and after treatment. Results: The skin stiffness at the superficial projection position of vastus lateralis, vastus medialis, vastus intermedius, medial gastrocnemius, and lateral gastrocnemius of patients in combined treatment group after treatment was significantly smaller than that in control group (with t values of 2.78, 2.04, 3.12, 2.01, and 2.35, respectively, P<0.05). The differences in skin stiffness between before and after treatment at the superficial projection position of the above-mentioned muscles of patients in combined treatment group was (65±23), (24±8), (25±8), (65±27), and (69±34) N/m, respectively, which were significantly larger than (49±23), (16±19), (8±9), (45±39), and (43±42) N/m in control group (with t values of -2.75 -2.35, -7.47, -2.33, and -2.64, respectively, P<0.05), and the mean differences between groups (95% confidence intervals) were 16 (5 to 28), 9 (1 to 17), 17 (12 to 21), 20 (3 to 36), and 26 (4 to 49) N/m, respectively. The circumferences at 10 cm and 20 cm below the inferior patellar border, mid-knee, and 10 cm and 20 cm above the superior patellar border of patients in combined treatment group after treatment were significantly smaller than those in control group (with t values of -2.41, -2.49, -2.44, -2.21, and -2.36, respectively, P<0.05). The circumference differences between before and after treatment at the above-mentioned locations of patients in combined treatment group were significantly larger than those in control group (with t values of 2.21, 3.62, 3.35, 4.14, and 3.89, respectively, P<0.05), and the mean differences between groups (95% confidence intervals) were 2.3 (0.1 to 4.6), 2.4 (1.0 to 3.8), 2.1 (0.8 to 3.4), 3.5 (1.6 to 5.4), and 3.4 (1.5 to 5.2) cm, respectively. The VAS scores of lower limb and the total Lymph-ICF-LL scores of patients in combined treatment group after treatment were significantly lower than those in control group (with t values of -2.46 and -2.63, respectively, P<0.05); the differences of VAS scores of lower limb and the total Lymph-ICF-LL scores between before and after treatment of patients in combined treatment group were significantly higher than those in control group (with t values of 2.34 and 3.32, respectively, P<0.05), and the mean differences between groups (95% confidence intervals) were 0.5 (0 to 0.9) and 6 (2 to 9), respectively. Conclusions: Combined application of ESWT and CDT shows superior efficacy in alleviating lower limb lymphedema and skin fibrosis after cervical cancer surgery, and can relieve pain and improve patients' quality of life.