下肢淋巴水肿治疗的最新进展
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摘要
在临床上,目前对下肢淋巴水肿的治疗主要集中在早期治疗,以预防病变的发展,而对晚期病例的治疗尚不能获得满意结果。西医治疗下肢淋巴水肿以对症处理为主,局部可用弹力绷带包扎,中医治疗下肢淋巴水肿以中药辨证论治为主,配合物理疗法。对于下肢淋巴水肿的整个疾病过程,目前临床治疗没有一个统一的标准,故在临床工作中需要进行总结,以指导临床治疗。
In clinic,the treatment of lower limb lymphedema is mainly focused on early treatment,in order to prevent the development of lesions,but the treatment of advanced cases is not a satisfactory result.Western medicine for the treatment of lower limb lymphedema is mainly symptomatic treatment,and it can be bandaged with elastic bandage.TCM treatment of lower limb lymphedema is mainly based on TCM syndrome differentiation,combined with physical therapy.For the whole disease process of lower limb lymphedema,there is not a unified standard in clinical treatment at present.Therefore,we need to summarize in clinical work to guide clinical treatment.
In clinic,the treatment of lower limb lymphedema is mainly focused on early treatment,in order to prevent the development of lesions,but the treatment of advanced cases is not a satisfactory result.Western medicine for the treatment of lower limb lymphedema is mainly symptomatic treatment,and it can be bandaged with elastic bandage.TCM treatment of lower limb lymphedema is mainly based on TCM syndrome differentiation,combined with physical therapy.For the whole disease process of lower limb lymphedema,there is not a unified standard in clinical treatment at present.Therefore,we need to summarize in clinical work to guide clinical treatment.
引文
[1]鞠伶伟,陈雷,刘兆喆,等.手法淋巴引流综合消肿疗法治疗双下肢淋巴水肿1例[J].创伤与急危重病医学,2017,5(2):88-90.
[2]李志连,蔡歆.1例血管化淋巴结移植术用于宫颈癌术后下肢淋巴水肿患者的护理[J].当代护士:中旬刊,2017,25(3):138-139.
[3]陈滢滢.吸脂减容术治疗下肢淋巴水肿围手术期护理对策及效果评价[J].中华肿瘤防治杂志,2016,23(S1):365-366.
[4]陆平,李晓刚,杨国凯,等.人工肌泵治疗下肢淋巴水肿的临床观察[J].中国民族民间医药,2014,23(3):56-57.
[5]陈雷,刘兆喆,谢晓冬.综合消肿疗法治疗恶性肿瘤术后下肢淋巴水肿临床研究[J].创伤与急危重病医学,2017,5(2):80-84.
[6]孙小红,孔为民,马正君.行为干预对妇科恶性肿瘤治疗后下肢淋巴水肿患者的作用[J].首都医科大学学报,2016,37(6):826-829.
[7]仪赫莫仁,高爽,王嘉桔,等.小牛血清去蛋白注射液在老年人感染性下肢淋巴水肿综合治疗中的作用[J].中国老年学杂志,2013,33(2):396-397.
[8]王忠堂,赖钊毅.穿通支皮瓣技术治疗“橡皮腿”1例[C].2013年全国中西医结合医学美容学术交流大会论文汇编[A].2013.
[9]柴琳琳,李喆,毕胜等.改良Charles法治疗晚期肢体淋巴水肿的临床疗效分析[J].第三军医大学学报,2013,35(20):2242-2244.
[10]王欣宇,杜建时,韩冬梅.淋巴管-静脉吻合术治疗妇科肿瘤术后下肢淋巴水肿的效果[J].中国老年学杂志,2017,37(24):6149-6151.
[11]曹卫刚,李圣利,周剑国,等.超声抽吸法治疗下肢原发性淋巴水肿[J].中华整形外科杂志,2006,22(4):290-291.
[12]侯传强.骨髓基质干细胞移植治疗肢体淋巴水肿的研究[D].济南:山东大学,2009.
[13]施越冬,张学军,徐剑炜,等.静脉淋巴管复合组织瓣移植在治疗下肢继发性淋巴水肿中的作用[J].中国临床医学,2005,12(5):831-834.
[14]朱力,牛星焘,马勇光,等.应用皮瓣桥接治疗阴囊及下肢淋巴水肿的疗效观察[J].中国微创外科杂志,2003,3(2):128-130.
[15]邵哲人,马奇,陶志平.自体网状皮片移植治疗下肢淋巴水肿[A].2008年浙江省医学美容暨整形外科学术会议论文汇编,2008.
[16]于仁义,陈存富,李江,等.病变组织切除皮肤回植术治疗晚期下肢淋巴水肿[J].中国美容医学,2008,17(9):1279-1281.
[17]洪伟,聂会勇,杨成林.针刺释放淋巴液配伍抗感染治疗下肢淋巴水肿并发急性丹毒31例临床观察[J].陕西医学杂志,2010,39(9):1215-1216.
[18]姚青勋,向丽娜.梅花针针刺治疗下肢淋巴水肿并发急性丹毒30例临床分析[J].内蒙古中医药,2014,33(29):45-46.
[19]李金.萆薢消肿丸治疗肢体淋巴水肿(湿热阻滞型)的临床观察[D].哈尔滨:黑龙江中医药大学,2017.
[20]董娟娟,齐容,张小花,等.武权生教授从气血辨治妇科恶性肿瘤根治术后下肢淋巴水肿经验[J].光明中医,2016,31(20):2941-2943.
[21]吴建萍.崔公让教授经验方治疗下肢淋巴水肿60例[J].光明中医,2014,29(2):243-244.
[22]马跃海,胡莹,李秋华,等.中药内服外治联合淋巴引流技术治疗中老年恶性肿瘤术后下肢淋巴水肿临床疗效研究[J].实用药物与临床,2017,20(5):520-523.
[23]Tidhar D,Drouin J,Shimony A.Aqua lymphatic therapy in managing lower extremity lymphedema[J].J Support Oncol,2007,5(4):179-83.
[24]Bontha V B,Abhay N N,Anna S K.A survey on foot care practices among filarial lymphoedema patients in Orissa,India[J].Trop Biomed,2007,24(2):7-14.
[25]Eyigor S,Karapolat H,Kirazli Y.Efficacy of etanercept and complete decongestive physical therapy in bilateral lower-limb lymphoedema associated with rheumatoid arthritis:a case report[J].Adv Ther,2008,25(1):23-28.
[26]Kim S J,Park Y D.Effects of complex decongestive physiotherapy on the oedema and the quality of life of lower unilateral lymphoedema following treatment for gynecological cancer[J].Eur J Cancer Care(Engl),2008,17(5):463-468.
[27]Brorson H,Ohlin K,Olsson G,et al.Controlled compression and liposuction treatment for lower extremity lymphedema[J].Lymphology,2008,41(2):52-63.
[28]Yamamoto T,Todo Y,Kaneuchi M,et al.Study of edema reduction patterns during the treatment phase of complex decongestive physiotherapy for extremity lymphedema[J].Lymphology,2008,41(2):80-86.
[29]Espinosa-de-Los-Monteros A,Hinojosa C A,Abarca L,et al.Compression therapy and liposuction of lower legs for bilateral hereditary primary lymphedema praecox[J].J Vasc Surg,2009,49(1):222-224.
[30]Lam P T,Wong M S,Tse C Y.Use of closed controlled subcutaneous drainage to manage chronic lower limb oedema in patients with advanced cancer[J].Hong Kong Med J,2009,15(1):65-68.
[31]Eryilmaz T,Kaya B,Ozmen S,et al.Suction-assisted lipectomy for treatment of lower-extremity lymphedema[J].Aesthetic Plast Surg,2009,33(4):671-673.
[32]van der Walt J C,Perks T J,Zeeman B J,et al.Modified Charles procedure using negative pressure dressings for primary lymphedema:a functional assessment[J].Ann Plast Surg,2009,62(6):669-75.
[33]Nakao F,Furutani A,Yoshimura K,et al.The outcomes of program based on complex decongestive physiotherapy for a patient with secondary lymphedema caused by infection on the leg[J].Fukuoka Igaku Zasshi,2009,100(6):235-241.
[34]Karonidis A,Chen H C.Preservation of toes in advanced lymphedema:an important step in the control of infection[J].Ann Plast Surg,2010,64(4):446-50.
[35]Brorson H.From lymph to fat:complete reduction of lymphoedema[J].Phlebology,2010,25(1):52-63.
[36]Mihara M,Hayashi Y,Hara H,et al.Early lymph-drainage massage using a cosmetic roller after lymphatico-venous anastomosis compared to manual lymph drainage:a case report[J].J Plast Reconstr Aesthet Surg,2011,64(12):1709-1711.
[37]Yamaguchi K,Kimata Y,Yamada K,et al.Peripheral venous angle plasty:a new lymphovenous anastomosis technique for lower extremitylymphedema[J].Plast Reconstr Surg,2012,130(1):233e-235e.
[38]Zaleska M,Olszewski WL,Jain P,et al.Pressures and timing of intermittent pneumatic compression devices for efficient tissue fluid and lymph flow in limbs with lymphedema[J].Lymphat Res Biol,2013,11(4):227-232.
[39]Pe?a Q Y,Hernández R P,Batista C J F,et al.Lymphoscintigraphy for the assessment of autologous stem cell implantation in chronic lymphedema[J].Clin Nucl Med,2015,40(3):217-9.
[40]Greene A K,Maclellan R A.Operative Treatment of Lymphedema Using Suction-Assisted Lipectomy[J].Ann Plast Surg,2016,77(3):337-40.
[41]Gerasimenko M Y,Knyazeva T A,V T,et al.The application of the method of kinesio-taping technique for the combined non-pharmacological rehabilitation of the patients presenting with lymphedema of the lower extremities[J].Vopr Kurortol Fizioter Lech Fiz Kult,2015,92(5):22-27.
[42]Lamprou D A,Voesten H G,Damstra R J,et al.Circumferential suction-assisted lipectomy in the treatment of primary and secondary endstage lymphoedema of the leg[J].Br J Surg,2017,104(1):84-89.
[2]李志连,蔡歆.1例血管化淋巴结移植术用于宫颈癌术后下肢淋巴水肿患者的护理[J].当代护士:中旬刊,2017,25(3):138-139.
[3]陈滢滢.吸脂减容术治疗下肢淋巴水肿围手术期护理对策及效果评价[J].中华肿瘤防治杂志,2016,23(S1):365-366.
[4]陆平,李晓刚,杨国凯,等.人工肌泵治疗下肢淋巴水肿的临床观察[J].中国民族民间医药,2014,23(3):56-57.
[5]陈雷,刘兆喆,谢晓冬.综合消肿疗法治疗恶性肿瘤术后下肢淋巴水肿临床研究[J].创伤与急危重病医学,2017,5(2):80-84.
[6]孙小红,孔为民,马正君.行为干预对妇科恶性肿瘤治疗后下肢淋巴水肿患者的作用[J].首都医科大学学报,2016,37(6):826-829.
[7]仪赫莫仁,高爽,王嘉桔,等.小牛血清去蛋白注射液在老年人感染性下肢淋巴水肿综合治疗中的作用[J].中国老年学杂志,2013,33(2):396-397.
[8]王忠堂,赖钊毅.穿通支皮瓣技术治疗“橡皮腿”1例[C].2013年全国中西医结合医学美容学术交流大会论文汇编[A].2013.
[9]柴琳琳,李喆,毕胜等.改良Charles法治疗晚期肢体淋巴水肿的临床疗效分析[J].第三军医大学学报,2013,35(20):2242-2244.
[10]王欣宇,杜建时,韩冬梅.淋巴管-静脉吻合术治疗妇科肿瘤术后下肢淋巴水肿的效果[J].中国老年学杂志,2017,37(24):6149-6151.
[11]曹卫刚,李圣利,周剑国,等.超声抽吸法治疗下肢原发性淋巴水肿[J].中华整形外科杂志,2006,22(4):290-291.
[12]侯传强.骨髓基质干细胞移植治疗肢体淋巴水肿的研究[D].济南:山东大学,2009.
[13]施越冬,张学军,徐剑炜,等.静脉淋巴管复合组织瓣移植在治疗下肢继发性淋巴水肿中的作用[J].中国临床医学,2005,12(5):831-834.
[14]朱力,牛星焘,马勇光,等.应用皮瓣桥接治疗阴囊及下肢淋巴水肿的疗效观察[J].中国微创外科杂志,2003,3(2):128-130.
[15]邵哲人,马奇,陶志平.自体网状皮片移植治疗下肢淋巴水肿[A].2008年浙江省医学美容暨整形外科学术会议论文汇编,2008.
[16]于仁义,陈存富,李江,等.病变组织切除皮肤回植术治疗晚期下肢淋巴水肿[J].中国美容医学,2008,17(9):1279-1281.
[17]洪伟,聂会勇,杨成林.针刺释放淋巴液配伍抗感染治疗下肢淋巴水肿并发急性丹毒31例临床观察[J].陕西医学杂志,2010,39(9):1215-1216.
[18]姚青勋,向丽娜.梅花针针刺治疗下肢淋巴水肿并发急性丹毒30例临床分析[J].内蒙古中医药,2014,33(29):45-46.
[19]李金.萆薢消肿丸治疗肢体淋巴水肿(湿热阻滞型)的临床观察[D].哈尔滨:黑龙江中医药大学,2017.
[20]董娟娟,齐容,张小花,等.武权生教授从气血辨治妇科恶性肿瘤根治术后下肢淋巴水肿经验[J].光明中医,2016,31(20):2941-2943.
[21]吴建萍.崔公让教授经验方治疗下肢淋巴水肿60例[J].光明中医,2014,29(2):243-244.
[22]马跃海,胡莹,李秋华,等.中药内服外治联合淋巴引流技术治疗中老年恶性肿瘤术后下肢淋巴水肿临床疗效研究[J].实用药物与临床,2017,20(5):520-523.
[23]Tidhar D,Drouin J,Shimony A.Aqua lymphatic therapy in managing lower extremity lymphedema[J].J Support Oncol,2007,5(4):179-83.
[24]Bontha V B,Abhay N N,Anna S K.A survey on foot care practices among filarial lymphoedema patients in Orissa,India[J].Trop Biomed,2007,24(2):7-14.
[25]Eyigor S,Karapolat H,Kirazli Y.Efficacy of etanercept and complete decongestive physical therapy in bilateral lower-limb lymphoedema associated with rheumatoid arthritis:a case report[J].Adv Ther,2008,25(1):23-28.
[26]Kim S J,Park Y D.Effects of complex decongestive physiotherapy on the oedema and the quality of life of lower unilateral lymphoedema following treatment for gynecological cancer[J].Eur J Cancer Care(Engl),2008,17(5):463-468.
[27]Brorson H,Ohlin K,Olsson G,et al.Controlled compression and liposuction treatment for lower extremity lymphedema[J].Lymphology,2008,41(2):52-63.
[28]Yamamoto T,Todo Y,Kaneuchi M,et al.Study of edema reduction patterns during the treatment phase of complex decongestive physiotherapy for extremity lymphedema[J].Lymphology,2008,41(2):80-86.
[29]Espinosa-de-Los-Monteros A,Hinojosa C A,Abarca L,et al.Compression therapy and liposuction of lower legs for bilateral hereditary primary lymphedema praecox[J].J Vasc Surg,2009,49(1):222-224.
[30]Lam P T,Wong M S,Tse C Y.Use of closed controlled subcutaneous drainage to manage chronic lower limb oedema in patients with advanced cancer[J].Hong Kong Med J,2009,15(1):65-68.
[31]Eryilmaz T,Kaya B,Ozmen S,et al.Suction-assisted lipectomy for treatment of lower-extremity lymphedema[J].Aesthetic Plast Surg,2009,33(4):671-673.
[32]van der Walt J C,Perks T J,Zeeman B J,et al.Modified Charles procedure using negative pressure dressings for primary lymphedema:a functional assessment[J].Ann Plast Surg,2009,62(6):669-75.
[33]Nakao F,Furutani A,Yoshimura K,et al.The outcomes of program based on complex decongestive physiotherapy for a patient with secondary lymphedema caused by infection on the leg[J].Fukuoka Igaku Zasshi,2009,100(6):235-241.
[34]Karonidis A,Chen H C.Preservation of toes in advanced lymphedema:an important step in the control of infection[J].Ann Plast Surg,2010,64(4):446-50.
[35]Brorson H.From lymph to fat:complete reduction of lymphoedema[J].Phlebology,2010,25(1):52-63.
[36]Mihara M,Hayashi Y,Hara H,et al.Early lymph-drainage massage using a cosmetic roller after lymphatico-venous anastomosis compared to manual lymph drainage:a case report[J].J Plast Reconstr Aesthet Surg,2011,64(12):1709-1711.
[37]Yamaguchi K,Kimata Y,Yamada K,et al.Peripheral venous angle plasty:a new lymphovenous anastomosis technique for lower extremitylymphedema[J].Plast Reconstr Surg,2012,130(1):233e-235e.
[38]Zaleska M,Olszewski WL,Jain P,et al.Pressures and timing of intermittent pneumatic compression devices for efficient tissue fluid and lymph flow in limbs with lymphedema[J].Lymphat Res Biol,2013,11(4):227-232.
[39]Pe?a Q Y,Hernández R P,Batista C J F,et al.Lymphoscintigraphy for the assessment of autologous stem cell implantation in chronic lymphedema[J].Clin Nucl Med,2015,40(3):217-9.
[40]Greene A K,Maclellan R A.Operative Treatment of Lymphedema Using Suction-Assisted Lipectomy[J].Ann Plast Surg,2016,77(3):337-40.
[41]Gerasimenko M Y,Knyazeva T A,V T,et al.The application of the method of kinesio-taping technique for the combined non-pharmacological rehabilitation of the patients presenting with lymphedema of the lower extremities[J].Vopr Kurortol Fizioter Lech Fiz Kult,2015,92(5):22-27.
[42]Lamprou D A,Voesten H G,Damstra R J,et al.Circumferential suction-assisted lipectomy in the treatment of primary and secondary endstage lymphoedema of the leg[J].Br J Surg,2017,104(1):84-89.