癌症病人的淋巴水腫照護

The Nursing Care of Lymphedema with Cancer Patients

淋巴水腫是癌症病人在接受癌症治療後或疾病惡化時可能長期伴隨的合併症之一。高蛋白的組織液累積於單側或雙側肢體造成癌症病人許多不適的困擾。淋巴水腫是癌症病人常見的困擾之一，腫脹的肢體常會影響病人的舒適與身體心像，進而降低生活品質。「完整淋巴水腫治療」(complete decongestive therapy)是目前公認針對淋巴水腫有效的物理治療，主要是合併皮膚照護、徒手淋巴按摩、壓縮治療及運動，能夠減少18.7-66%的水腫。完整淋巴水腫治療雖能夠有效的減少肢體的腫脹，但對於以生活品質為優先考量的癌症晚期病人而言，肢體腫脹減輕的多或少相對較不重要，因此建議癌症晚期病人的淋巴水腫治療目標，應視病人的預估存活期，並了解病人的期待，而調整所給予的治療計畫。

Lymphedema may be a long-existing complication during cancer treatment or progression of other diseases. Lymphedema is the result of lymphatic fluid accumulation in the affected limb(s) of the patient. Extreme swelling of the limb causes poor quality of patient daily life because of discomfort and poor body image. Complete decongestive therapy (CDT) is the most effective physical therapy for patients with lymphedema. CDT combines skin care, massage along the lymphatic vessels, compression therapy, and exercise. With the treatment of CDT, patient's swelling of extremities can be reduced by 18.7~66%. However, managing uncomfortable symptoms and improving quality of life are more important than reducing the extremity's swelling in patients with end-of-life cancer. Therefore, the treatment goal and the plan for the patient with lymphedema should be based on the patient's anticipatory life span and the individual's expectation.