目的

采用两两比较Meta 分析和网状Meta 分析相结合的方法，对不同针灸疗法治疗乳腺癌术后上肢淋巴水肿（BCRL）的疗效和腧穴配伍优效性进行评价。

方法

计算机检索中国期刊全文数据库（CNKI）、万方数据知识服务平台（Wanfang）、维普中文科技期刊数据库（VIP）、中国临床试验注册中心（ChiCTR）、 Web of Science、Cochrane Central Register of Controlled Trials （CENTRAL）、EMbase、PubMed、Mednar 数据库中针灸疗法治疗BCRL 相关症状的随机对照试验（RCT）文献，检索时限为建库至2024年5月31 日。 由2 位评价员独立筛选文献、提取资料及评价纳入研究的偏倚风险后，运用RevMan 5.3 和Stata 15.0 软件对数据进行分析。

结果

共检索文献1624 篇，最终9 篇RCT 被纳入分析，总样本量为452 例。 Meta 分析显示，手针组与对照组在改善患肢肘上10 cm 处臂围方面比较，差异无统计学意义［MD＝-1.3，95%CI（-2.71，0.10），P＝0.07］；温针灸组和力动针组与空白对照组在改善患健肢腕横纹处臂围差方面比较，差异无统计学意义［MD ＝-0.13，95%CI（0.37，0.11），P ＝0.09］；温针灸组与空白对照组在减轻患健肢腕横纹和腕横纹上5 cm 处围度差方面比较，差异无统计学意义［MD＝0.07，95%CI（-0.29，0.43），P＝0.35］；温针灸在改善BCRL 的淋巴水肿有效指数方面，其效果显著优于地奥司明片［MD＝27.63，95%CI（24.73，30.52），P＜0.001］。 网状Meta 分析结果显示，在治疗BCRL 方面，不同配穴方式同空白对照和药物治疗之间累积排序曲线下面积排序：远近配穴（83.3%）＞等待治疗（66.9%）＞药物治疗（48.8%）＞局部配穴（1.0%）。

结论

温针灸能够改善BCRL 整体症状，且推荐远近配穴的取穴方案。 但由于纳入文献量较少且质量不一，仍需要更多高质量RCT 进一步证实。

Objective

This study combines pairwise Meta-analysis and network Meta-analysis to evaluate the efficacy of different acupuncture therapies in treating postoperative upper limb lymphedema（BCRL） after breast cancer surgery and to assess the optimal acupoint selection strategies.

Methods

A comprehensive literature search was conducted across multiple databases，including CNKI，Wanfang，VIP，ChiCTR，Web of Science，Cochrane Central Register of Controlled Trials （CENTRAL），Embase，PubMed，and Mednar，covering studies published up to May 31，2024. Randomized controlled trials（RCTs） investigating acupuncture interventions for BCRL were included. Two independent reviewers screened the literature，extracted data，and assessed the risk of bias. Data analysis was performed using RevMan 5.3 and Stata 15.0.

Results

A total of 1624 articles were identified and 9 RCTs with a combined sample size of 452 participants were included.Meta-analysis revealed that manual acupuncture alone showed no significant difference in reducing arm circumference of the affected limb at the upper 10 cm of the elbow when compared with the control group ［MD＝-1.3，95% CI （-2.71，0.10）， P＝0.07］. Similarly，no significant difference was observed in wrist circumference reduction between the warm acupuncture or force-dynamic acupuncture groups and the blank control group ［MD ＝-0.13，95% CI （0.37，0.11）， P ＝0.09］. Furthermore，warm acupuncture did not demonstrate a statistically significant reduction in the difference between wrist circumference and the circumference 5 cm above the wrist compared to the blank control group ［MD＝0.07，95% CI （-0.29，0.43），P＝0.35］. However，warm acupuncture showed a significant advantage over diosmin tablets in improving the lymphatic edema index ［MD ＝27.63，95% CI （24.73，30.52）， P＜0.001］. Network Meta-analysis results indicated that among different acupoint selection strategies，distal-proximal acupoint combination exhibited the highest cumulative probability of effectiveness （83.3%），followed by waiting treatment （66.9%），drug therapy（48.8%），and local acupoint selection （1.0%）.

Conclusion

Warm acupuncture is effective in alleviating BCRL symptoms，and the distal-proximal acupoint combination is recommended as the preferred acupoint selection strategy. However，due to the limited number and variable quality of the included literature，further high-quality RCTs are needed to confirm these findings.