蠲浊通络方治疗脾虚湿阻型妇科肿瘤术后下肢淋巴水肿的临床疗效OA

Objective To observe the clinical efficacy of Juanzhuo Tongluo Formula in treating lower limb lymphedema(LLL)after gynecological tumor surgery in patients with spleen-deficiency and dampness-obstruction syndrome.Methods Patients with LLL after gynecological tumor surgery admitted to the Oncology Department of the Affiliated Hospital of Nanjing University of Chinese Med-icine,Jiangsu Provincial Hospital of Traditional Chinese Medicine from January 2024 to July 2025 were selected.They were randomly divided into observation group(50 cases,with 1 case dropped out)and control group(50 cases,with 1 case excluded)using a random number table method.The observation group received Juanzhuo Tongluo Formula combined with complex decongestive therapy(CDT),while the control group received diosmin combined with CDT.The treatment course was 4 weeks for both groups.The circumferences of the affected lower limb at different sites,bioelectrical impedance,extracellular water,segmental water of the affected limb,levels of interleukin(IL)-6,IL-1 β,tumor necrosis factor-α(TNF-α),Lymphedema Quality of Life Questionnaire(LYMQOL)scores,and traditional Chinese medicine(TCM)syndrome scores were compared between the two groups before and after treatment.The therapeutic efficacy was evaluated at the end of treatment.Results The total effective rate in the observation group was 89.80％,which was higher than that in the control group(65.31％),with a statistically significant difference(P=0.004).The abso-lute risk difference was 24.50％(95％CI:0.081 2 to 0.408 6),and Cramer's V was 0.293,indi-cating a moderate difference.After treatment,the circumferences of the dorsum of the foot,lateral malleolus tip,superior border of the patella,10 cm above the superior border of the patella,and 10 cm below the inferior border of the patella of the affected lower limb in both groups were smaller than those before treatment,and the circumferences in the observation group were smaller than those in the control group(P＜0.05).The effect sizes(Cohen's d)for the changes in circumferences were as follows:dorsum of the foot,0.467(95％CI:0.066 to 0.868);lateral malleolus tip,1.582(95％CI:1.129 to 2.036);superior border of the patella,2.538(95％CI:2.004 to 3.073);10 cm above the superior border of the patella,1.861(95％CI:1.386 to 2.337);and 10 cm below the inferior border of the patella,1.852(95％CI:1.377 to 2.326).At week 4 of treatment,the 50 Hz bioelectrical impedance values in both groups were higher than those before treatment,and the val-ues in the observation group were higher than those in the control group,with statistically significant differences(P＜0.05).The extracellular water and segmental water of the affected limb in both groups were lower than those before treatment,and the values in the observation group were lower than those in the control group,with statistically significant differences(P＜0.05).At week 4 of treatment,the levels of IL-6,IL-1 β,and TNF-α in both groups were lower than those before treat-ment,and the levels in the observation group were lower than those in the control group,with statis-tically significant differences(P＜0.05).At week 4 of treatment,the scores of the"function""appearance""symptoms"and"mood"dimensions in the LYMQOL in both groups were lower than those before treatment,and the scores in the observation group were lower than those in the control group,with statistically significant differences(P＜0.05).The"overall quality of life"scores in both groups were higher than those before treatment,and the scores in the observation group were higher than those in the control group,with statistically significant differences(P＜0.05).At week 4 of treatment,the TCM syndrome scores in both groups were lower than those before treatment,and the scores in the observation group were lower than those in the control group,with statistically sig-nificant differences(P＜0.05).Conclusion Juanzhuo Tongluo Formula has a significant thera-peutic effect on LLL after gynecological tumor surgery in patients with spleen-deficiency and damp-ness-obstruction syndrome.It can reduce the circumference of the affected limb,alleviate edema,decrease the expression of inflammatory cytokines,and improve the quality of life.