ObjectiveTo summarize the application progress of indocyanine green (ICG) angiography in diagnosis and treatment of lymphedema.MethodsThe literature related to dynamic imaging tracing of lymphedema at home and abroad was reviewed extensively. And the research status and progress of ICG angiography in diagnosis and treatment of lymphedema were retrospectively analyzed.ResultsICG angiography can be used as the gold standard for the diagnosis of lymphedema at present and the classification of lymphedema severity, selection of surgical incisions and methods, and intraoperative operation. It can also be used to observe lymphatic drainage and regeneration within 1.5 cm of subcutaneous and determine the prognosis.ConclusionCompared with traditional methods, ICG angiography has more obvious advantages and value in diagnosis and treatment of lymphedema. However, it also has problems such as slow development speed and difficulty in developing deep lymphatic vessels (nodes).
Objective To review the clinical progress of microsurgical management for lymphedema. Methods The literature on microsurgical treatment for lymphedema at home and abroad in recent years was reviewed and analyzed. Results At present, conservative treatment is the main treatment for lymphedema, which has limited effectiveness only for early stages of lymphedema; and it is not curative and demands patient compliance. In contrast, microsurgical approaches can solve the problems in the prevention or management of lymphedema and showed promising results, such as lymphatic-venous anastomosis (LVA), vascularized lymph node transfer (VLNT), and other lymphatic reconstructions. Conclusion Microsurgical approaches like LVA and VLNT have been broadly used in recent years, the effectiveness and safety have been proved. But the evidence of long-term randomized controlled studies is still required to establish standard treatment practices.
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.
ObjectiveTo review the progress of treatment and prevention of breast cancer related lymphedema. MethodsThe recent literature concerning treatment and prevention of breast cancer related lymphedema was extensively consulted and reviewed. ResultsThe treatment of lymphedema is now based on complete decongestive therapy, supplemented with medicine and surgery. Those procedures have been proved to be safe and effective. Sentinel lymph node biopsy, axillary reverse mapping, and lymphaticovenous anastomoses have been used to decrease the incidence of lymphedema. They show promising effectiveness in short term, but the long-term effectiveness needs further tests. ConclusionIn clinical practice, many treatment methods are used to decrease lymphedema, and lymphedema prevention is playing an increasingly important role. Lymphaticovenous anastomoses shows a promising effectiveness in reducing lymphedema.
Objective To summarize the research progress of combined surgical treatment of lymphedema based on vascularized lymph node transfer (VLNT), and to provide systematic information for combined surgical treatment of lymphedema. MethodsLiterature on VLNT in recent years was extensively reviewed, and the history, treatment mechanism, and clinical application of VLNT were summarized, with emphasis on the research progress of VLNT combined with other surgical methods. Results VLNT is a physiological operation to restore lymphatic drainage. Multiple lymph node donor sites have been developed clinically, and two hypotheses have been proposed to explain its mechanism for the treatment of lymphedema. But it has some inadequacies such as slow effect and limb volume reduction rate less than 60%. To address these inadequacies, VLNT combined with other surgical methods for lymphedema has become a trend. VLNT can be used in combination with lymphovenous anastomosis (LVA), liposuction, debulking operation, breast reconstruction, and tissue engineered material, which have been shown to reduce the volume of affected limbs, reduce the incidence of cellulitis, and improve patients’ quality of life. ConclusionCurrent evidence shows that VLNT is safe and feasible in combination with LVA, liposuction, debulking operation, breast reconstruction, and tissue engineered material. However, many issues need to be solved, including the sequence of two surgeries, the interval between two surgeries, and the effectiveness compared with surgery alone. Rigorous standardized clinical studies need to be designed to confirm the efficacy of VLNT alone or in combination, and to further discuss the subsistent issues in the use of combination therapy.
The Influence of microwave and hot water immersion hyperthermia on the lymphedematous skin of lower extremity on 12 patients was studied by using immunohistochemical and lymphoscintigraphic methods. We assumed that the subsidence of inflammatory changes in the lymphedematous limb and/or local absorption of tissue fluid protein following local microwave heating, but not the augmented lymph How seemed to be responsible for the reduction of edema.
ObjectiveTo summarize the progress of the roles and mechanisms of various types of stem cell-based treatments and their combination therapies in both animal studies and clinical trials of lymphedema. MethodsThe literature on stem cell-based treatments for lymphedema in recent years at home and abroad was extensively reviewed, and the animal studies and clinical trials on different types of stem cells for lymphedema were summarized.ResultsVarious types of stem cells have shown certain effects in animal studies and clinical trials on the treatment of lymphedema, mainly through local differentiation into lymphoid endothelial cells and paracrine cytokines with different functions. Current research focuses on two cell types, adipose derived stem cells and bone marrow mesenchymal stem cells, both of which have their own advantages and disadvantages, mainly reflected in the therapeutic effect of stem cells, the difficulty of obtaining stem cells and the content in vivo. In addition, stem cells can also play a synergistic role in combination with other treatments, such as conservative treatment, surgical intervention, cytokines, biological scaffolds, and so on. However, it is still limited to the basic research stage, and only a small number of studies have completed clinical trials. ConclusionStem cells have great transformation potential in the treatment of lymphedema, but there is no unified standard in the selection of cell types, the amount of transplanted cells, and the timing of transplantation.
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。
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.
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.