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Effectiveness of lymphedema management and physiological mechanisms.

淋巴水肿治疗和生理机制的有效性。

基本信息

批准号：
20500466
负责人：
TSUJI Tetsuya
金额：
$ 2.83万
依托单位：
Keio University
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (C)
财政年份：
2008
资助国家：
日本
起止时间：
2008 至 2010
项目状态：
已结题

项目摘要

【PURPOSE】Multi-layer inelastic lymphedema bandaging (MLLB) or hosiery (elastic stockings) combined with exercises, skin care, and manual lymphatic drainage therapy is recommended as an intensive phase of treatment for lymphedema patients. Recently, anastomosis of lymph vessels to the venous system may be attempted in patients with lymphedema, and produces better results at earlier stages of lymphedema. The purpose of this study is to compare the effect of MLLB and anastomosis of lymph vessels to the venous system.【METHODS】A retrospective case-control study was undertaken in the setting of the lymphedema Clinic, the Keio University Hospital, Tokyo. The women with secondary lymphedema of the lower limbs, caused by cancer of the uterine cervix and body, and ovarian cancer were enrolled. The interventions consisted of MLLB alone combined with exercises, skin care, and manual lymphatic drainage therapy (MLLB group), MLLB and hosiery combined with those (MLLB and hosiery group), and anastomo … More sis of lymph vessels to the venous system (operation group). Operation group followed by MLLB after receiving operation. The main outcome measure was the reduction in circumference of lower limb at AK10 (10cm above the superior pole of the patella), BK10 (10cm below the inferior pole of the patella), BK20 (20cm below the inferior pole of the patella), and ANKLE (just above the medial and lateral malleolus).【RESULTS】The circumference of lower limb decreased significantly in MLLB group (N=13), MLLB and hosiery group (N=15), and operation group (N=17). The circumference at AK10, BK10, BK20, and ANKLE in the one month decreased significantly in MLLB group and operation group, whilst the circumference at ANKLE decreased significantly in MLLB and hosiery group (paired t-test). Concerning the comparison among three groups, the circumference at AK20, BK20, and ANKLE decreased in MLLB more than operation group, and the circumference at BK20, and ANKLE decreased in operation group more than MLLB and hosiery group (two-way ANOVA and Fisher'sPLSD test).【CONCLUSIONS】MLLB alone, MLLB and hosiery, and anastomosis of lymph vessels to the venous system followed by MLLB as an initial phase of treatment for lymphedema patients obtained the sustained limb volume reduction than hosiery alone. Although lymphatic grafting requires microsurgical techniques, it was suggested to show promising results in carefully selected patients. Less

[目的]建议采用多层无弹性水肿绷带（MLLB）或袜（弹力袜）结合运动、皮肤护理和手工淋巴引流治疗作为水肿患者的强化治疗阶段。最近，淋巴管与静脉系统的吻合术可以尝试用于水肿患者，并且在水肿的早期阶段产生更好的结果。本研究的目的是比较MLLB和淋巴管与静脉系统吻合的效果。[方法]在东京庆应义塾大学附属医院水肿门诊进行回顾性病例对照研究。研究对象为子宫颈癌、子宫体癌和卵巢癌引起的继发性下肢水肿患者。干预措施包括单独的MLLB结合运动、皮肤护理和手工淋巴引流治疗（MLLB组），MLLB和袜子结合这些治疗（MLLB和袜子组），以及使用传统的淋巴引流治疗（MLLB和袜子组）。 ...更多信息淋巴管与静脉系统吻合（手术组）。手术组术后行MLLB。主要结局指标为AK 10（髌骨上级上方10 cm）、BK 10（髌骨下极下方10 cm）、BK 20（髌骨下极下方20 cm）和踝关节（内踝和外踝上方）处下肢周长的减少。[结果]下肢围度明显减小的有：MLLB组（N=13）、MLLB+袜组（N=15）和手术组（N=17）。MLLB组和手术组1个月内AK10、BK 10、BK 20和ANKLE处的围度显著降低，而MLLB和袜组1个月内ANKLE处的围度显著降低（配对t检验）。三组比较，MLLB组AK20、BK 20和ANKLE处的周长比手术组减少更多，手术组BK 20和ANKLE处的周长比MLLB和袜组减少更多（双因素ANOVA和Fisher'sPLSD检验）。[结论]单用MLLB、MLLB+袜子、淋巴管与静脉系统吻合后MLLB作为治疗下肢水肿的初始阶段，较单用袜子获得了持续的肢体体积减少。虽然淋巴管移植需要显微外科技术，但建议在精心挑选的患者中显示出有希望的结果。少