Effectiveness of lymphedema management and physiological mechanisms.

【目的】多层非弹性淋巴水肿包扎（MLLB）或袜（弹力袜）结合运动、皮肤护理和手工淋巴引流治疗是淋巴水肿患者的强化治疗阶段。近年来，淋巴血管与静脉系统的吻合可以尝试用于淋巴水肿患者，在淋巴水肿的早期阶段效果较好。本研究的目的是比较MLLB和淋巴管吻合对静脉系统的影响。【方法】在东京庆应义塾大学附属医院淋巴水肿门诊进行回顾性病例对照研究。妇女继发性下肢淋巴水肿，引起的宫颈癌和身体，卵巢癌被纳入。干预措施包括：单用MLLB联合运动、皮肤护理、手工淋巴引流治疗（MLLB组），MLLB与袜子联合（MLLB与袜子组），将淋巴管与静脉系统吻合（手术组）。手术组术后再行MLLB。主要观察指标为下肢AK10（髌骨上极以上10cm）、BK10（髌骨下极以下10cm）、BK20（髌骨下极以下20cm）和踝关节（内踝和外踝正上方）围度的减少。【结果】MLLB组（N=13）、MLLB与袜子组（N=15）、手术组（N=17）下肢围度明显减小。MLLB组和手术组患者1个月内AK10、BK10、BK20、踝关节围度显著降低，MLLB组和袜子组患者1个月内踝关节围度显著降低（配对t检验）。三组比较，MLLB组的AK20、BK20、踝关节围度下降幅度大于手术组，手术组的BK20、踝关节围度下降幅度大于MLLB组和袜子组（双因素方差分析和Fisher’splsd检验）。【结论】单用MLLB、MLLB联合袜子、淋巴血管与静脉系统吻合后再用MLLB作为淋巴水肿患者的初始治疗阶段，比单用袜子治疗获得了持续的肢体体积缩小效果。虽然淋巴移植需要显微外科技术，但建议在精心挑选的患者中显示有希望的结果。少

【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