积极应对乳腺癌术后淋巴水肿

Actively dealing with lymphedema after breast cancer operation

淋巴水肿至今仍被普遍认为是不可治愈,甚至是无法治疗的。通常,完善的体格检查和排除性的诊断技术可以明确诊断乳腺癌术后淋巴水肿而并不需要专业的诊断技术。从淋巴水肿综合保守治疗,到以核素淋巴显像、MRI为代表的诊断技术,到以淋巴管静脉吻合术、吸脂术、淋巴结移植术为代表的外科手术的开展,淋巴水肿的诊断与治疗已有较大进步。针对淋巴回流梗阻,淋巴管功能损害,组织间淋巴液淤滞、脂肪增生、纤维化的病生理改变,分期手术治疗,包括一期肢体减容整形手术,二期肱动脉旁深淋巴管静脉吻合术,绝大部分病例可明显缓解。当前淋巴水肿诊断治疗理念变化显著,积极应对乳腺癌术后淋巴水肿,将成为该领域的发展趋势。

Breast cancer may be curable, but lymphedema is not curable by now. Usually,the diagnosis of lymphedema is not difficult though perfect physical examination and exclusive diagnostic techniques, without the need for professional diagnostic techniques. But the effect of lymphedema therapy is not always satisfactory. Conservative therapy, such as complex decongestive therapy （CDT）, is usually accepted, then the diagnosis and treatment technique have got great improvement, such as emission computed tomography（ECT）, MRI, lymphantic-vein-anastomasis （LVA）, liposuction and lymph node transplantation. For dealing with the obstruction of lymph circulation, impairment of lymphatic vessels, lymphatic stasis, adipose hyperplasia and fibrillation caused by lymphedema, we developed staging operation： stageⅠ, liposuction to reduce volume; stageⅡ, deep lymphatic vessel-tributary of brachial vein-anastomasis, to improve the lymphatic circulation. Most of our lymphedema cases got obvious remission. The principle of diagnosis and therapy of lymphedema is changing currently, actively dealing with lymphedema after breast cancer is a trend.