皮下组织抽吸加弹力压迫治疗乳腺癌术后上肢淋巴水肿

目的 探讨乳腺癌术后上肢淋巴水肿的治疗方法。方法 2001年6月～2003年9月选择乳腺癌术后上肢淋巴水肿2年以上的患者11例，患侧上肢明显水肿，外观增粗，前臂中点周径与健侧平均相差4．4cm，上臂中点周径与健侧平均相差6.6cm，活动受限，其中2例有丹毒反复发作。利用肿胀吸脂技术，对其水肿的上肢进行皮下组织抽吸去除，术后弹力加压3个月后，改为每晚弹力加压，观察疗效。结果 经6～15个月随访，11例患者的上肢淋巴水肿明显减轻，外观缩小，平均上臂周径较术前减小4cm，无丹毒发生。结论 皮下组织抽吸加适时弹力压迫治疗乳腺癌术后上肢淋巴水肿，方法简便，近期有效。     

手动负压抽吸联合血管化淋巴结移植治疗继发性下肢淋巴水肿的疗效分析

目的 探讨手动负压抽吸联合血管化淋巴结移植治疗继发性下肢淋巴水肿的临床疗效。方法 回顾性分析2018年11月至2021年11月接受联合治疗的12例妇科恶性肿瘤术后继发性下肢淋巴水肿患者的临床资料。患肢大腿采用手动负压抽吸减容,同时取锁骨上血管化淋巴结移植至患侧小腿。比较治疗前后患肢周径变化;记录治疗前后丹毒发作情况及生活质量的改变。结果 患肢大腿抽取脂肪组织500～1 200 mL,平均（917±196） mL。术后患肢周径明显减小（P<0.05）。治疗后随访期间所有患者均无丹毒发作,主观症状均较术前明显好转。结论 手动负压抽吸联合血管化淋巴结移植治疗下肢淋巴水肿疗效确切,值得推广。     

皮瓣转移结合负压抽吸治疗乳腺癌术后上肢淋巴水肿

目的 探讨一种治疗乳腺癌根治术后上肢淋巴水肿的手术方法。方法 2001～2002年我们采用侧胸壁皮瓣或背阔肌肌皮瓣转移结合上肢负压抽吸治疗10例单侧乳腺癌根治术后上肢淋巴水肿患者。结果 术后所有患者上肢周径均有不同程度减小，核素淋巴管造影显示淋巴回流有显著改善。术后随访3～18个月，疗效稳定。结论 皮瓣转移结合负压抽吸可以有效地治疗乳腺癌根治术后淋巴水肿。     

肢体淋巴水肿的外科治疗及研究进展

肢体淋巴水肿是一种常见病和多发病，其治疗方法可分为保守治疗和外科治疗两大类，目的均是改善淋巴液生成与回流之间的平衡，促进或恢复淋巴回流，减小周径。随着对淋巴水肿发病机理的不断阐明，外科治疗方案也在不断改变，现对其外科治疗方法及研究进展做一回顾与探讨。１病变组织切除１．１负压抽吸法负压抽吸法是一种比较新的治疗肢体淋巴水肿的方法，20世纪80年代后期始用于临床。Brorson等[1～4]对该方法进行了系列报道，认为抽吸法与压迫疗法相结合治疗乳癌术后淋巴水肿非常有效，患肢水肿在术后3个月、12个月分别减少87%和97%，患…     

肿胀麻醉下负压抽吸法治疗乳腺痛术后上肢淋巴水肿

目的:研究肿胀麻醉下负压抽吸法治疗乳腺癌术后上肢淋巴水肿的治疗效果及预后.方法:应用肿胀麻醉下负压抽吸法治疗乳腺癌术后上肢淋巴水肿9例,在上肢的肿胀部位作多个小切口,插入吸引管,在0.8～1.0MPa负压下将瘀积的淋巴液和增生的脂肪组织吸出,术后配合弹力压迫疗法.结果:随访6～15个月,肢体明显缩小,质地变软,取得显著近期效果.结论:肿胀麻醉下负压抽吸法治疗乳腺癌术后上肢淋巴水肿,切口小,创伤轻,对非严重纤维化的患者是一种安全有效的治疗方法.     

负压抽吸法治疗四肢淋巴水肿

目的　介绍应用负压抽吸法治疗四肢淋巴水肿。方法　应用抽吸法治疗四肢淋巴水肿35例,在肢体的肿胀部位作多个小切口,插入吸引管,在负0.8～0.9个大气压下将淤积的淋巴液和增生的脂肪组织吸出,术后配合压迫疗法。结果　随访3～6个月,肢体明显缩小,质地变软,取得显著近期效果。结论　负压吸引法治疗四肢淋巴水肿,切口小,创伤轻,对非严重纤维化的患者是一种安全有效地治疗方法,其近期效果明显,远期效果有待进一步观察。     

负压抽吸法治疗四肢淋巴水肿

目的　介绍应用负压抽吸法治疗四肢淋巴水肿。方法　应用抽吸法治疗四肢淋巴水肿 35例 ,在肢体的肿胀部位作多个小切口 ,插入吸引管 ,在负 0 .8～ 0 .9个大气压下将淤积的淋巴液和增生的脂肪组织吸出 ,术后配合压迫疗法。结果　随访 3～ 6个月 ,肢体明显缩小 ,质地变软 ,取得显著近期效果。结论　负压吸引法治疗四肢淋巴水肿 ,切口小 ,创伤轻 ,对非严重纤维化的患者是一种安全有效地治疗方法 ,其近期效果明显 ,远期效果有待进一步观察。     

手法淋巴引流综合治疗肢体慢性淋巴水肿

目的 探讨采用手法淋巴引流治疗慢性淋巴水肿的新方法.方法 50例慢性肢体淋巴水肿患者接受了手法淋巴引流综合消肿治疗,对体表(包括躯干和肢体)淋巴系统沿淋巴回流方向和途径做轻柔的按压和按摩.50例中原发性淋巴水肿29例,继发性21例;下肢患病42例,上肢患病8例.采用多频生物电阻人体成分分析仪检测组织水肿和测量肢体周径检验治疗效果.结果 经过1～2个疗程的治疗,50例患病肢体的水肿均有不同程度的减轻,表现为患肢组织水肿程度显著减轻(P＜0.05)和患肢周径的显著缩小(P＜0.05).肢体周径与组织水肿变化的相关性检验表明两者有非常显著的相关性(rs=0.774,P＜0.01).结论 手法淋巴引流综合治疗的有效地促进滞留组织淋巴水肿的回流,减轻肢体的肿胀,改善患肢的外形,是治疗慢性淋巴水肿有效的治疗手段.     

背阔肌淋巴结皮瓣游离移植治疗淋巴水肿围手术期的护理经验

目的总结背阔肌淋巴结皮瓣游离移植治疗淋巴水肿的围手术期的护理方法。方法 2020年5月至2022年5月, 中山大学附属第一医院显微创伤手外科应用背阔肌淋巴结皮瓣游离移植治疗下肢淋巴水肿患者15例, 病程4个月～15年, 平均6.13年, 淋巴水肿分期为Ⅱ～Ⅲ期;在围手术期构建和实施标准化护理干预, 包括术前肢体肿胀监测、淋巴引流手法按摩和使用弹力袜, 术后常见并发症的观察和护理、改良淋巴引流手法按摩、制定淋巴水肿患者康复手册、开展淋巴水肿患者延续性护理和"互联网+"护理模式等标准化护理措施, 采用门诊及微信随访, 比较术后移植皮瓣成活例数、肿胀肢体周径及是否出现淋巴管炎。结果 15例患者移植皮瓣均成活。随访6～12个月, 临床症状均有改善, 淋巴管炎发作频率较术前减少, 水肿肢体手术前、后的下肢周径分别为(42.85±6.96)cm、(40.24±8.61)cm, 在髌骨下缘远侧5.0 cm平面, 术后患侧周径较术前改善1.0～9.1 cm, 手术后患侧与健侧的周径差值较术前明显减小(P=0.04)。结论背阔肌淋巴结皮瓣游离移植结合围手术期的标准化护理干预措施能有效促进移植皮瓣成活和肿...     

携带淋巴结的组织瓣移植治疗下肢淋巴水肿

目的 探讨携带淋巴结的组织瓣移植治疗下肢淋巴水肿的疗效。方法 2019年6月至2021年6月,采用携带淋巴结的组织瓣移植治疗Ⅱ～Ⅲ期下肢淋巴水肿5例,皮瓣大小（10～30） cm×（4～9） cm,受区选择患肢小腿区,受区血管为胫前动脉及伴行静脉,术后定期随访。结果 1例皮瓣术后部分坏死,予以换药对症治疗后,创面瘢痕愈合,其余4例移植皮瓣顺利成活。术后随访0.5～2年,患肢周径于术后1个月及6个月平均减少0.84 cm及2.29 cm,术后未出现淋巴管炎,供区未出现淋巴漏及淋巴水肿。结论 应用淋巴结皮瓣移植治疗肢体淋巴水肿近期疗效较好,供区无并发症,是早中期下肢淋巴水肿可选择的治疗方法之一。     

手法淋巴引流治疗乳腺癌术后上肢淋巴水肿

目的 探讨运用手法淋巴引流(Manual Lymph Drainage,MLD)治疗乳腺癌术后上肢淋巴水肿的疗效。方法2008年至2012年,101例乳腺癌术后上肢淋巴水肿患者按治疗前患肢与健肢的周径(d)差值分3组:A组(d5 cm)。3组患者均进行1个疗程(15 d)的淋巴水肿综合消肿治疗(Complex Decongestive Therapy,CDT):手法淋巴引流+低弹性绷带包扎。通过检测引流前后健患侧的组织水分和肢体周径,计算水分比率与周径比率,同时调查患者对手法引流及绷带使用情况的主观感受,以观察并评价患者对治疗的适应性和接受度。组织水分采用多频生物电阻人体成分分析仪进行检测。结果 101例患者经CDT治疗后,患肢组织水分和肢体周径均呈显著下降(PB组>A组(P<0.01),即治疗效果与水肿严重程度成正比。几乎所有患者对治疗方法及效果表示满意。结论 CDT能有效促进乳腺癌术后上肢淋巴水肿的淋巴回流,减轻患肢水肿,改善患肢外形,帮助功能恢复,并且该治疗对水肿程度较重的患者疗效尤其显著。     

Lymphosuction – a new treatment modality for chronic filarial lymphedema

The surgical treatment of filaritic lymphedema despite various well reasoned attempts in the past to improve function and contour has to date defied cure. The technique of blunt suction lipectomy has been applied in eight cases and it appears to be well tolerated with encouraging short term results. The final results were accepted favourably by the patients because of smaller incisions, instant improvement in contour, reduction in weight of limb in addition to simple and minimal postoperative care required. Based on our findings, lymphosuction can be a useful treatment modality in mild grades of filarial lymphedema, though further long term clinical observations and studies are required to define its exact indications and limitations. Severe cases require lymphosuction plus excisional debulking. Received: 17 January 1996 / Accepted: 15 July 1997     

肢体慢性淋巴水肿CDT治疗后低弹力绷带使用时长对远期疗效的影响

目的 探讨肢体慢性淋巴水肿CDT(Complex decongestion therapy)治疗后低弹绷带使用时长对于长期疗效的影响。方法 2016至今,对57例淋巴水肿患者按治疗结束后自我使用低弹绷带包扎时长（t）分为A(>1年)、B(0.5～1年)、C(<0.5年)3组。采用多频生物电阻人体成分分析仪测量组织水分,卷尺测量肢体周径。比较3组患者复诊时与治疗结束时水分和周径的变化。结果 A组在维持肢体周径、水分方面明显优于B组和C组,B组则优于C组（P<0.05）。3组治疗后的丹毒发作频率均有改善,A组改善最为明显（P<0.05）。结论 肢体慢性淋巴水肿患者在CDT治疗结束后应继续使用低弹绷带包扎患肢,坚持使用越久的患者长期疗效越好。     

Supramicrosurgical lymphaticovenular anastomosis for the treatment of lymphedema in the extremities]

During the past eight years, we treated obstructive lymphedema of a unilateral upper extremity in 27 females and of a unilateral or bilateral lower extremity in 35 males and females with supramicrosurgical lymphaticovenular anastomoses and/or conservative treatment. The most common cause of upper limb edema was mastectomy with or without subsequent radiation therapy for breast cancer, and that of lower limb edema was hysterectomy with radiation. As an objective assessment of edema, the circumferences of the affected and opposite normal forearms or lower legs were measured 10 cm below the olecranon of the arm or the lower border of the patella. In patients who received conservative treatment (12 arms and 12 legs), the average excess circumferential length of the affected arm and leg was 6.4 and 7.1 cm over that of normal extremities, average duration of edema before treatment was 3.5 and 5.2 years, average period for conservative treatment was 10.6 months and 1.5 years, and average decreased circumferential length was 0.8 and 0.6 cm, respectively. The rate of circumferential decrease over 4 cm was none in arm and 16.7% in leg edema. In patients who underwent surgery (12 arms and 16 legs), the average excess circumferencial length was 8.9 and 9.8 cm, average duration of edema before surgery was 8.2 and 8.9 years, average follow-up after surgery was 2.2 and 3.3 years, and average decrease in excess circumference was 4.1 and 2.7 cm, respectively. The rate of circumferential decrease over 4 cm was 58.3% in arms and 50% in legs. These results indicate that supramicrolymphaticovenular anastomoses have a valuable place in the treatment of obstructive lymphedema.     

Can a practicing surgeon detect early lymphedema reliably?

BACKGROUND: Lymphedema may be identified by simpler circumference changes as compared with changes in limb volume. METHODS: Ninety breast cancer patients were prospectively enrolled in an academic trial, and seven upper extremity circumferences were measured quarterly for 3 years. A 10% volume increase or greater than 1 cm increase in arm circumference identified lymphedema with verification by a lymphedema specialist. Sensitivity and specificity of several different criteria for detecting lymphedema were compared using the academic trial as the standard. RESULTS: Thirty-nine cases of lymphedema were identified by the academic trial. Using a 10% increase in circumference at two sites as the criterion, half the lymphedema cases were detected (sensitivity 37%). When using a 10% increase in circumference at any site, 74.4% of cases were detected (sensitivity 49%). Detection by a 5% increase in circumference at any site was 91% sensitive. CONCLUSIONS: An increase of 5% in circumference measurements identified the most potential lymphedema cases compared with an academic trial.     

Long-term follow-up after lymphaticovenular anastomosis for lymphedema in the leg

Over the last 9 years, the authors analyzed lymphedema of the lower extremity in a total of 25 patients, comparing the use of supermicrosurgical lymphaticovenular anastomosis and/or conservative treatment. The most common cause of edema was hysterectomy, with or without subsequent radiation therapy for uterine cancer. Among 12 cases that underwent only conservative treatment, only one case showed a decrease of over 4 cm in the circumference of the lower leg. The average period for conservative treatment was 1.5 years, and the average decreased circumference was 0.6 cm (8 percent of the preoperative excess). Thirteen patients were followed after lymphaticovenular anastomoses, as well as pre- and postoperative conservative treatment. The average follow-up after surgery was 3.3 years, and eight patients showed a reduction of over 4 cm in the circumference of the lower leg. The average decrease in the circumference, excluding edema in the bilateral leg, was 4.7 cm (55.6 percent of the preoperative excess). These results indicate that supermicrosurgical lymphaticovenular anastomosis has a valuable place in the treatment of lymphedema.     

Low-level laser therapy in management of postmastectomy lymphedema

The aim of this paper was to study the effects of low-level laser therapy (LLLT) in the treatment of postmastectomy lymphedema. Eleven women with unilateral postmastectomy lymphedema were enrolled in a double-blind controlled trial. Patients were randomly assigned to laser and sham groups and received laser or placebo irradiation (Ga-As laser device with a wavelength of 890 nm and fluence of 1.5 J/cm2) over the arm and axillary areas. Changes in patients' limb circumference, pain score, range of motion, heaviness of the affected limb, and desire to continue the treatment were measured before the treatment and at follow-up sessions (weeks 3, 9, 12, 18, and 22) and were compared to pretreatment values. Results showed that of the 11 enrolled patients, eight completed the treatment sessions. Reduction in limb circumference was detected in both groups, although it was more pronounced in the laser group up to the end of 22nd week. Desire to continue treatment at each session and baseline score in the laser group was greater than in the sham group in all sessions. Pain reduction in the laser group was more than in the sham group except for the weeks 3 and 9. No substantial differences were seen in other two parameters between the two treatment groups. In conclusion, despite our encouraging results, further studies of the effects of LLLT in management of postmastectomy lymphedema should be undertaken to determine the optimal physiological and physical parameters to obtain the most effective clinical response.     

Recent advances in microlymphatic surgery in China

Development and advances in clinical and research work on limb lymphedema in China has progressed rapidly in recent years. The authors first performed successful lymphaticovenous anastomosis using the operating microscope for limb lymphedema in China in May, 1979. By 1983, surgery on 48 lymphedematous limbs in the authors' clinic had given good results in one-third of the cases. By the same year, 185 limbs with lymphedema were treated by lymphaticovenous anastomosis throughout China with excellent results achieved in 72.9% of the cases. Lymphology was investigated using animal models, intraluminal pressure, and venous graft substitution of lymphatics.