Sopracordevole Francesco, Mancioli Francesca, Canzonieri Vincenzo, Buttignol Monica, Giorda Giorgio, Ciavattini Andrea
Department of Gynecological Oncology, Oncological Referral Center, National Cancer Institute, Aviano, Pordenone 33081, Italy.
Department of Woman's Health Sciences, Polytechnic University of Marche, Ancona 60123, Italy.
Oncol Lett. 2015 Apr;9(4):1889-1892. doi: 10.3892/ol.2015.2961. Epub 2015 Feb 12.
Vulvar lymphedema is an uncommon and disabling side-effect of pelvic lymphadenectomy and pelvic radiotherapeutic treatment for invasive genital cancer. Lymphorrhea, a complication of lymphedema, may be extremely distressing for patients due to the requirement to wear sanitary towels and as the pain and loss of elasticity of the vulvar skin and mucosa can cause discomfort during coitus. Surgical treatments of lymphorrhea and vulvar lymphedema secondary to gynecological cancer treatments remain controversial and are not currently considered to be the standard therapy. The present study reports two cases of vulvar lymphedema complicated by vulvar lymphorrhea in females who had undergone treatment for cervical and endometrial cancer, respectively; a review of the literature is also included. In the two present cases, vulvar lymphedemas were refractory to standard treatments, including decongestive therapy, manual lymph drainage, elastic bandaging, low-stretch bandaging, exercises and skin care. Laser CO excision and vaporization of the whole skin and mucosal tissue of the vulva was successfully performed to treat the lymphorrhea and improve quality of life. Thus, the present two cases indicated that laser CO surgery may present an additional therapy for the treatment of genital lymphedema that is refractory to other treatments.
外阴淋巴水肿是盆腔淋巴结清扫术和盆腔放射治疗侵袭性生殖器癌罕见且致残的副作用。淋巴漏是淋巴水肿的一种并发症，由于需要使用卫生巾，且外阴皮肤和黏膜的疼痛及弹性丧失会在性交时引起不适，可能会给患者带来极大困扰。妇科癌症治疗继发的淋巴漏和外阴淋巴水肿的手术治疗仍存在争议，目前不被视为标准疗法。本研究报告了两例分别接受过宫颈癌和子宫内膜癌治疗的女性患者，她们的外阴淋巴水肿并发外阴淋巴漏；同时还包括文献综述。在这两例患者中，外阴淋巴水肿对包括消肿治疗、手法淋巴引流、弹性绷带包扎、低弹性绷带包扎、运动和皮肤护理在内的标准治疗均无效。成功实施了激光二氧化碳切除并汽化外阴全层皮肤和黏膜组织以治疗淋巴漏并改善生活质量。因此，这两例患者表明，激光二氧化碳手术可能为治疗对其他治疗无效的生殖器淋巴水肿提供一种额外的治疗方法。
