Vignes S
Unité de lymphologie, Centre national de référence des maladies vasculaires rares (lymphœdèmes primaires), hôpital Cognacq-Jay, 15, rue Eugène-Millon, 75015 Paris, France.
J Mal Vasc. 2014 Feb;39(1):57-61. doi: 10.1016/j.jmv.2013.11.003. Epub 2013 Dec 6.
Two questions arise when considering the treatment of varicose veins and the development of lymphedema: can the treatment cause lymphedema? Can it worsen it? Primary lymphedema is rarely associated with varicose veins except in the lymphedema-distichiasis syndrome. Data available in the literature is essentially based on surgical treatment. Stripping on a normal limb may induce chronic lymphedema in almost 0.1% of cases. The risk of lymphedema after stripping in patients with previous pelvic surgery including lymph node excision and/or radiotherapy remains unknown. In patients with lower limb lymphedema wearing strong elastic compression stockings, stripping provides little clinical improvement and can worsen volume. The main objective is also to avoid venous complications. Lymphatic lesions related to stripping can be evaluated by lymphography or lymphoscintigraphy. New techniques for treating varicose veins (sclerotherapy, endovenous laser treatment, radiofrequency ablation) seem to induce fewer lymphatic complications. Further studies are required to confirm these results. Indications for treatment should be unquestionable and patients must be alerted to the potential risk of lymphedema or its worsening.
治疗会导致淋巴水肿吗？会使其恶化吗？除了淋巴水肿-双行睫综合征外，原发性淋巴水肿很少与静脉曲张相关。文献中的现有数据基本上基于手术治疗。在正常肢体上进行剥脱术在几乎0.1%的病例中可能诱发慢性淋巴水肿。既往有包括淋巴结切除和/或放疗在内的盆腔手术的患者进行剥脱术后发生淋巴水肿的风险仍然未知。对于患有下肢淋巴水肿且穿着强力弹性压缩袜的患者，剥脱术几乎不能带来临床改善，反而可能使肿胀加重。主要目标还在于避免静脉并发症。与剥脱术相关的淋巴管病变可通过淋巴管造影或淋巴闪烁显像进行评估。治疗静脉曲张的新技术（硬化疗法、静脉内激光治疗、射频消融）似乎引发的淋巴并发症较少。需要进一步研究来证实这些结果。治疗指征应明确无误，并且必须提醒患者注意淋巴水肿或其恶化的潜在风险。
