Therapy Approaches for Lymphedema
Therapy Approaches for Lymphedema
复制标题
淋巴水肿的治疗方法
作者：
P. Mortimer
淋巴水肿，无论病因如何，基本上是不可治愈的，但存在不同的治疗方法，用于控制肿胀。治疗的目的是减少肿胀，恢复形状，并防止炎症发作，如复发性蜂窝织炎。主要有三种治疗方法：物理治疗，药物治疗和手术治疗。任何水肿都是由于毛细血管过滤和淋巴引流之间的不平衡引起的。物理治疗的原理是a）减少过度的毛细血管过滤和B）改善间质液和大分子从充血区域到正常引流淋巴结部位的引流。这是通过一个锡永，运动，如果可能的话，按摩相结合。控制复发性炎症发作只能通过糖尿病类型的皮肤护理，减少肿胀，必要时预防性使用抗生素来实现。药物治疗包括利尿剂或香豆素/类黄酮类药物。单纯性水肿使用利尿剂在生理学上是不合理的，但在混合性水肿和姑息性（癌症）情况下可能有用。香豆素/类黄酮已被证明可以减少所有类型的水肿肿胀。手术是指在早期阶段的面部肿胀，其中视力是compromised，或生殖器水肿，其中泌尿生殖功能受到影响。否则，只有在替代疗法失败时才应进行减容手术。显微手术治疗某些形式的水肿仍在评估中。
Lymphedema, regardless of etiology, is essentially incurable but different therapy approaches exist which serve to contain swelling. The objectives of treatment are to reduce swelling, restore shape, and prevent inflammatory episodes, eg, recurrent cellulitis. There are essentially three main approaches to lymphedema treatment: physical therapy, drug therapy, and surgery. Any edema arises from an imbalance between capillary filtration and lymph drainage. The principle of physical therapy is to a) reduce excessive capillary filtration and b) improve drainage of interstitial fluid and macromolecules from congested regions to normally draining lymph node sites. This is achieved through a combination of compres sion, exercise, and if possible, massage. Control of recurrent inflammatory episodes can only be achieved through diabetic type skin care, a reduction in swelling, and if necessary, prophylactic antibiotics. Drug therapy comprises diuretics or the coumarin/flavonoid group of drugs. The use of diuretics for pure lymphedema is physiologically unsound but may be of use in edema of mixed origin and in palliative (cancer) circumstances. Coumarin/flavonoids have been shown to reduce swelling in all types of lymphedema. Surgery is indicated at an early stage for facial swelling, where vision is compro mised, or genital lymphedema, where genitourinary function is affected. Otherwise, reducing operations should only be performed when alternative therapy has failed. Microsurgery for certain forms of lymphedema continues to be evaluated.