PDF(Pubmed)
Abstract：
Lymphedema is caused by dysfunction of the lymphatic system. It is divided into primary edema with no apparent cause and secondary edema with an exogenous cause. The main symptoms are edema and heaviness, skin changes such as skin hardening, lymphocysts, lymphorrhoea, papillomas, and recurrent cellulitis. They are often irreversible and progressive, thus greatly reducing quality of life of the patients. Diagnosis is made by image examinations that can evaluate lymphatic flow and functions such as lymphoscintigraphy and indocyanine green fluorescence lymphangiography. Linear pattern and dermal backflow are the main findings. Conservative treatment consists of four components: compression therapy with elastic garments, exercise therapy, manual lymphatic drainage, and skin care, which is called complex physical therapy (CPT). Although CPT has become the gold standard of treatment, with evidence of efficacy reported in terms of volume reduction, maintenance, and prevention of cellulitis, it is a symptomatic treatment and does not improve impaired lymphatic flow. On the other hand, surgical treatment, such as lymphaticovenous anastomosis and vascularized lymph node transplantation, can create new lymphatic flow and improve lymphatic dysfunctions. Although these techniques are expected to be effective in volume reduction, cellulitis prevention, and improving quality of life, there is a need for more studies with a higher level of evidence in the future. In Japan, lymphedema is treated with a combination of conservative and surgical therapies, but lymphedema is intractable and few cases are completely cured. Therefore, how to improve the outcome of treatment is an important issue to be addressed in the future. (This is a translation of Jpn J Vasc Surg 2023; 32: 141-146.).
摘要：
淋巴水肿是由淋巴系统功能障碍引起的。分为无明显原因的原发性水肿和有外源性原因的继发性水肿。主要症状是水肿和沉重，皮肤变化，如皮肤硬化，淋巴囊肿,淋巴结肿大,乳头状瘤,和复发性蜂窝织炎。它们往往是不可逆转的和渐进的，从而大大降低了患者的生活质量。通过可以评估淋巴流动和功能的图像检查进行诊断，例如淋巴闪烁显像和吲哚菁绿荧光淋巴管造影。线性模式和真皮回流是主要发现。保守治疗包括四个部分：弹性服装的压缩疗法，运动疗法,手动淋巴引流，和皮肤护理，这就是所谓的复杂物理治疗（CPT）。虽然CPT已成为治疗的黄金标准，根据体积减少的证据报告了疗效，维护,和预防蜂窝织炎，这是一种对症治疗，并不能改善淋巴流动受损。另一方面,手术治疗,如淋巴静脉吻合术和血管化淋巴结移植，可以创造新的淋巴流动和改善淋巴功能障碍。尽管这些技术有望有效减少体积，蜂窝织炎的预防，提高生活质量，未来需要更多证据水平更高的研究.在日本,淋巴水肿采用保守治疗和手术治疗相结合，但是淋巴水肿是棘手的，很少病例能完全治愈。因此,如何改善治疗效果是未来需要解决的重要问题。（这是JpnJVascSurg2023的翻译；32：141-146。).
