Kim D I, Huh S, Hwang J H, Kim Y I, Lee B B
Division of Vascular Surgery, Samsung Medical Center, College of Medicine, Sung kyun kwan University, Seoul, Korea.
Lymphology. 1999 Mar;32(1):11-4.
To determine whether there is anatomical and/or functional impairment to venous return in patients with lymphedema, we examined venous dynamics in 41 patients with unilateral leg lymphedema. A Volometer was used for computer analysis of leg volume, a color Duplex Doppler scanner was used to determine deep vein patency and skin thickness, and Air-plethysmography was used to assess ambulatory venous pressure, venous volume, venous filling index and the ejection fraction. In the lymphedematous leg, volume and skin thickness were uniformly increased (126.4 +/- 21.3% and 156.9 +/- 44.5%) (mean +/- S.D.), respectively. The ambulatory venous pressure was also increased (134 +/- 60.7%) as was the venous volume (124.5 +/- 37.5%), and the venous filling index (134.5 +/- 50.5%). The ejection fraction was decreased (94.9 +/- 26.1%). Greater leg volume correlated with increased venous volume and venous filling index (values = 0.327, 0.241, respectively) and decreased ejection fraction (r = -0.133). Increased subcutaneous thickness correlated with increased venous filling index and venous volume (r = 0.307, 0.126, respectively) and decreased ejection fraction (r = -0.202). These findings suggest that soft tissue edema from lymphatic stasis gradually impedes venous return which in turn aggravates the underlying lymphedema.
为了确定淋巴水肿患者静脉回流是否存在解剖学和/或功能损害，我们检查了41例单侧下肢淋巴水肿患者的静脉动力学。使用体积描记仪对腿部体积进行计算机分析，使用彩色双功多普勒扫描仪确定深静脉通畅情况和皮肤厚度，使用空气容积描记法评估动态静脉压、静脉容量、静脉充盈指数和射血分数。在淋巴水肿的下肢，体积和皮肤厚度分别均匀增加（分别为126.4±21.3%和156.9±44.5%）（平均值±标准差）。动态静脉压也升高（134±60.7%），静脉容量（124.5±37.5%）和静脉充盈指数（134.5±50.5%）也是如此。射血分数降低（94.9±26.1%）。更大的腿部体积与静脉容量增加和静脉充盈指数增加相关（值分别为0.327、0.241），与射血分数降低相关（r=-0.133）。皮下厚度增加与静脉充盈指数增加和静脉容量增加相关（r分别为0.307、0.126），与射血分数降低相关（r=-0.202）。这些发现表明，淋巴淤滞引起的软组织水肿逐渐阻碍静脉回流，进而加重潜在的淋巴水肿。
