消肿乳糜清系列制剂治疗乳糜尿和淋巴水肿的临床研究

目的探索乳糜尿、淋巴水肿和慢性淋巴管／结炎等疑难疾病的最佳治疗药物。方法研制应用消肿乳糜清口服液、生药片剂、较大剂量生药片剂和浸膏胶囊剂治疗丝虫性和其它病因的乳糜尿、乳糜血尿315例,研制应用消肿乳糜清注射液、口服液、生药片剂和浸膏胶囊剂治疗各种病因的淋巴水肿（象皮肿）和淋巴水肿合并淋巴管／结炎者分别为341例、313例。结果经1～7个月治疗后总有效率为93．48％～100％,其中乳糜尿、淋巴水肿和淋巴管／结炎的治愈率（淋巴水肿为基本治愈和显效率）分别为98．11％、73．91％和95．85％。治疗期间和疗毕后1～5年观察,95％以上的患者疗效稳定,亦未发现明显的毒副反应。而对照组（乙胺嗪治疗组）治疗前后无显著统计学差异（P〉0．05）。结论该药是目前乳糜尿、乳糜血尿、肢体淋巴水肿（象皮肿）和慢性淋巴管／结炎患者理想的天然治疗药物。     

淋巴水肿的外科治疗

淋巴水肿是一种临床常见的慢性进展性疾病,严重影响患者身心健康.对于难治性Ⅱ、Ⅲ期淋巴水肿,外科治疗是最佳选择.本文结合文献,介绍淋巴水肿外科治疗的现状,并就将来可能的发展进行展望.     

Effectiveness of the treatment-phase of two-phase complex decongestive physiotherapy for the treatment of extremity lymphedema

Background Complex decongestive physiotherapy (CDP) consists of a two-phase treatment program and is the international standard therapy for lymphedema. However, this therapy is not performed at most hospitals in Japan. Methods The subjects of the present study were 82 Japanese women with lymphedema of an extremity (median age, 64 years; range, 40–86 years). The volume of the affected extremity was compared before and after therapy, and the duration of the CDP treatment phase and rate of edema reduction were ascertained. The associations between the effect of CDP and duration of lymphedema, operative procedure, and radiotherapy were also investigated. Results For patients with upper-extremity lymphedema, the median duration of the CDP treatment phase was 6 treatment days (range, 3–26 days), median reduction of edema volume was 328.7 ml (range, 76.6–1258.0 ml; P = 0.0014), and median rate of edema reduction was 58.9% (range, 42.7%–97.1%). For patients with lower-extremity lymphedema, the median duration of the CDP treatment phase was 10 treatment days (range, 2–35 days), median reduction of edema volume was 1573.7 ml (range, 293.9–3471.1 ml; P < 0.0001), and median rate of edema reduction was 73.4% (range, 29.2%–117.3%). Although no correlation was seen between duration of lymphedema and duration of the CDP treatment phase or rate of edema reduction, the degree of lymph node dissection tended to influence rate of edema reduction in patients with lower-extremity lymphedema. Conclusion In a study of Japanese women with lymphedema, CDP comprising a two-phase treatment program was clearly effective.     

老年象皮肿病人行全髋关节置换术 1例

目的总结罕见的老年象皮肿病人行全髋关节置换术的治疗经验。方法总结宜兴市人民医院骨科 2020年 4月收治的 1例老年象皮肿病人行全髋关节置换术围手术期的治疗与康复措施。结果 79岁老年女性,术前诊断:左股骨颈骨折、象皮肿。病人有着 22年下肢淋巴水肿病史。完善术前检查后行左全髋关节置换术,术前仔细备皮,术中无菌操作,术后予低分子肝素、间歇充气加压装置等防止血栓,予白蛋白、血浆支持治疗,病人恢复满意。结论积极的术前准备和多措施预防血栓是行全髋关节置换术的老年象皮肿病人围手术期治疗的关键。     

居家康复锻炼对乳腺癌患者术后淋巴水肿治疗的作用

目的探讨居家康复锻炼对乳腺癌患者术后淋巴水肿的治疗效果。 方法选取2019年10月至2021年4月期间在中南大学湘雅医学院附属海口医院肿瘤化疗科治疗的乳腺癌术后淋巴水肿患者80例,采用随机分组将患者平均分为2组,对照组保持通常的自我护理,锻炼组在对照组的基础上给予患者居家康复训练指导,并通过检测患者淋巴水肿手臂周径大小、患肢间体积差异、肩部关节运动范围、手臂肌肉力量、生活质量等方面评估康复锻炼对淋巴水肿治疗的作用。 结果2组患者在经过为期至少6周的干预康复后,与对照组相比,锻炼组的淋巴水肿手臂周径大小有所下降（P＜0.05）,手臂体积也随之变小（P＜0.05）;锻炼组的肩关节运动范围恢复情况相比对照组显著提高（P＜0.05）。此外,在锻炼组中患者的手臂屈曲肌、外展肌、外旋肌、内旋肌和水平内收肌的肌力水平都显著增强（P＜0.05）;最后通过乳腺癌患者生命质量测定量表（FACT-B表）对患者生活质量进行评估之后发现,锻炼组患者各方面的生活质量都有所改善。 结论康复锻炼对于乳腺癌患者术后淋巴水肿的治疗是安全有效的,在一定程度上,有益于淋巴水肿的康复和预后,这为居家康复锻炼治疗乳腺癌术后淋巴水肿治疗提供了参考依据。     

Evaluation of Simplified Lymphatic Microsurgical Preventing Healing Approach (SLYMPHA) for the prevention of breast cancer-related lymphedema after axillary lymph node dissection using bioimpedance spectroscopy

BackgroundLymphedema is a serious complication of axillary lymph node dissection (ALND) with an incidence rate of 20%. Simplified Lymphatic Microsurgical Preventing Healing Approach (SLYMPHA) is a safe and relatively simple method, which decreases incidence of lymphedema dramatically. Our initial study showed an 88% decrease in clinical lymphedema rate. In the initial study, we used arm circumference measurement for the diagnosis of lymphedema and median follow up was 15 months. The aim of this study was to confirm these results after a long-term follow up period and by using bioimpedance spectroscopy (L-Dex) technology in detecting lymphedema.Study designAll patients, undergoing ALND with or without SLYMPHA between January 2014 and November 2020 were included in the study. Patients with no postoperative L-Dex measurements were excluded. A L-Dex score outside the normal range (±10 L-Dex unit) or ≥10 L-Dex unit increase above patient's baseline was considered as lymphedema. The incidence of lymphedema was compared between patients with and without SLYMPHA.Results194 patients were included in the study. 57% of cohort underwent SLYMPHA. Mean follow-up time was 47 ± 37 months. Patients, who underwent SLYMPHA, had a significantly lower rate of lymphedema (16% vs 32%; p = 0.01; OR 0.4 [0.2–0.8]).ConclusionSLYMPHA is a safe and relatively simple method, which continued its efficacy after a long-term follow up period. It should be considered as an adjunct procedure to ALND for all patients during initial surgery.     

DIEP flap breast reconstruction combined with vascularized lymph node transfer for patients with breast cancer-related lymphedema

IntroductionLymphedema is a condition which heavily impacts patients QoL. For patients who desire autologous breast reconstruction, lymph nodes can be included in the Deep Inferior Epigastric Artery (DIEP) flap combining vascularized lymph node transfer and autologous breast reconstruction.Material and methodsPatients who received autologous breast reconstruction with a DIEP flap in combination with vascularized lymph nodes were included in this study. Volume measurements pre and post-surgery were analyzed and surveys including two versions of the ULL-27 questionnaire to measure QoL before and after surgery were send.ResultsIn total, 45 out of 64 patients returned the questionnaires. The average follow up was 51 months. The total ULL-27 score increased with 12.6 points on average (p = 0.00). The subdomain scores (physical, psychological and social) also significantly increased (p = 0.00). In addition 69% of patients were able to decrease physiotherapy, 63% of patients were able to decrease compression garment usage and the incidence of skin infections decreased in 6 patients out of 7 patients who had recurrent skin infections prior to surgery. The volume difference between the affected and the healthy arm did not significantly change (407 ml–406 ml, p = 0.988).ConclusionsVascularized lymph node transfer in combination with DIEP flap breast reconstruction can cause a significant improvement on lymphedema related QoL, even when a volume difference decrease is absent. It can also decrease compression garment usage and reduce the need for physiotherapy. Future prospective studies should evaluate these findings and identify patients that benefit most from such procedures.     

背阔肌肌皮瓣移转治疗乳癌根治术后上肢淋巴水肿

目的　减轻乳癌根治术及放疗后上肢淋巴水肿。方法　采用带蒂背阔肌肌皮瓣移转一期完成治疗乳癌根治术加根治量放疗后所致上肢严重淋巴水肿伴胸壁放射性溃疡、上肢上举受限 12例。结果　肌皮瓣成活良好 ,上肢淋巴水肿明显减轻 (消肿率达 5 1%～ 67% ) ,上举功能明显改善 (达 10 0～ 110度 ) ,随访 1～ 3年未见复发。结论　本手术简单、省时、安全、有效 ,不仅能减轻肢体淋巴水肿 ,还可修复胸壁塌陷畸形 ,解除腋部瘢痕牵扯 ,改善上肢上举功能 ,因此 ,不失为一种可行的治疗乳癌根治术后继发上肢淋巴水肿的方法。