目的探讨肢体淋巴水肿疾病中相关恶性肿瘤的诊断与治疗。方法对我院 1988年10月至2000年12月收治的332例肢体淋巴水肿患者，根据临床表现，用B超、淋巴管造影、静脉造影或CT等手段作为病因诊断检查，对可疑恶性肿瘤病例用穿刺、局部切除或局部探查的方法共活检20例。结果检出由恶性肿瘤引发的淋巴水肿18例,其中原发淋巴系统恶性肿瘤4例，均为下肢； 继发性淋巴结转移癌14例，上、下肢各7例，并予相应治疗。结论重视本病临床表现，可使患者获得及早诊断，及时治疗。
Objective To study a new method of treatment for upper limb lymphedema after radical mastectomy. Methods From Jun. 2001 to Sep. 2003, 11 cases(2with complication of erysipelas ) of upper limb lymphedema being treated with radical mastectomy for more than 2 years were used as model. All the edema of limbs was sucked from hypodermis with liposuction technique and compressed with compression garment. Three months after operation, elasticity stress was conducted every night. Results The reduction of the edema of upper limbswas remarkable. The average decrease of circumference was 4 cm. No erysipelas was observed. Conclusion The liposuction technique and elasticity stress is a new and effective approach to the treatment of upper limb lymphedema.
OBJECTIVE To observe the character of local and systemic immune responses in chronic limb lymphedema, and to investigate the effect of microwave on immunological response. METHODS From November 1996 to February 1998, 27 patients with chronic limb lymphedema were adopted in this study. Among them, there were 11 males and 16 females, the average age was 36.6 years. These patients were classified as the experimental group and 10 healthy volunteers as the control group. Before and after microwave heating and bandaging treatment, T and B lymphocyte in peripheral blood and skin infiltrating cells in the patients and volunteers were detected and phenotyped with alkaline phosphatase-anti-alkaline phosphatase(APAAP) and avidin biotin peroxidase complex (ABC) immunohistochemical methods respectively. RESULTS There were decreases of CD4+ T lymphocyte and the ratio of CD4+/CD8+ in peripheral blood and predominant dermal perivascular T lymphocyte infiltration in chronic limb lymphedema patients. After two courses of microwave heating and bandaging treatment, it was found that the number of CD4+ T lymphocytes increased and the ratio of CD4+/CD8+ was restored to normal levels, and dermal perivascular T lymphocyte infiltration decreased greatly. CONCLUSION Microwave heating and bandaging treatment can modulate the systemic and local immunological imbalance of chronic limb lymphedema.
Abstract Sixty-four cases of upper limb lymphedema following radical operation of carcinoma of breast were treated by microwave therapy. The course of treatment was divided into two stages. Each stage was one hour a day for 20 days. Elastic band was put on the limb betweenevery therapy except the time of sleeping at night. After 1 months to 2 years follow-up, the results showed: symptoms disappeared obviously; the edema had gone down (Plt;0.01). The relapse frequency of erysipelas-like syndrome decreased obviously (Plt;0.01). The skin elasticity restored, and no complication appeared. It was concluded that microwave therapy was an effective conservative treatment in treating upper limb lymphedema following radical operaion of carcinoma of breast.
Twenty patients with chronic lymphedema had been treated by microwave heating. T-lympocyte subpopulation and HLA-DR phenotype of peripheral blood in patientswith lymphedema were examined by using dual colour flow cytometry before and after treatment. We found that CD4 (T helpe/inducer) in chronic lymphedema decreased significantly (Plt;0.01), HLA-DR increased significantly (P lt;0.05). After the microwave treatment, the CD4, CD4/CD8 ratio increased significantly; HLA-DR, HLA-DR+CD+8 lymphocyte reduced. It was clear that microwave could regulate the immunological disorder of lymphedema patients.
By using biochemical assessment technique and histological examination,a comparative study of the cutaneous tissues in 16 patients with lymphedema of the lower extremity before and after the heating and bandage therapy, and it was noted thatthe heating and bandage therapy might:(1) the content of hydroxyproline in the affected skin would be decreased; (2) the thickness of skin was decreased and the water content was reduced; (3) the microcirculation of local tissues was enhanced, and (4) the activity of the macrophages was increased. In conjunction with the criteria of clinical observation, the action mechanism of heating and bandage therapy might be as follows: (1) improve the local microcirculation and enhance the resorption of tissue fluid and the protein, and (2) increase the activity of the macrophages, and minimize the extent of fibrosis of the affected tissues.
Thirteen cases of unilateral lymphedema of lower extremity were treated by the anastomosis between the suporficial and deep lymphaties. The rate of subeidence of edema at 2 weeks and 6 months after operation were 57.1±18.5%and 47.3± 22.9%, respectively, It was believed that this type of oporation had the advantageS of anastomosis on the tissues of same origin, unlikely occurrence of thrombosis at the anastomotic stoma, small incision, less surgical trauma and acceptable by patients.
There are various types of methods to treat lymphedema. A new pneumatic compression device have been developed. Thirty patients with lymphedema were treated by cyclic pneumatic compression device with satisfactory results. After treatment, the reduction in size of the edematous limbs was obvious. The indications, mechanism of action, advantages and drawbacks of the therapeutic method were discussed.