Vignes Stéphane, Vidal Florence, Arrault Maria
Department of Lymphology, Centre National de Référence des Maladies Vasculaires Rares (Lymphoedèmes Primaires), Hôpital Cognacq-Jay, Paris, France.
Vasc Med. 2017 Aug;22(4):331-336. doi: 10.1177/1358863X17714884. Epub 2017 Jun 20.
Lymphedema, a chronic debilitating disease, is not always easily diagnosed. A total of 254 new patients ((217 women, 37 men), median (Q1-Q3) age 61 (46-72) years) were referred for suspected limb lymphedema to an exclusively lymphedema-dedicated department for a first consultation (January - March 2015) were included; among 118 with upper limb involvement, 100 (84.7%) were diagnosed with post-breast cancer therapy and four with primary lymphedemas; among 136 with lower limb involvement, 31 (22.8%) were diagnosed with primary lymphedemas and 35 (25.7%) with post-cancer lymphedemas. The main alternative diagnoses were: 32 (45.7%) lipedemas/lipo-lymphedemas and 21 (30%) chronic venous insufficiencies. Age at symptom onset, body mass index, referral origins and first-symptom-to-specialized-consultation intervals differed between primary, post-cancer lymphedema and alternative diagnosis patients. Among the entire cohort, 57 (22.4%) had cellulitis. For all 135 (53.1%) upper or lower limb post-cancer lymphedemas and the 119 (46.9%) others, the median (Q1-Q3) first-symptom-to-specialized-consultation intervals were 1.4 (0.7-3.8) and 4 (1.1-18.8) years, respectively ( p < 0.0001). Specialized consultations confirmed primary and post-cancer lymphedema diagnoses and identified others, especially for patients with suspected lower limb lymphedema.
淋巴水肿是一种慢性致残性疾病，并不总是易于诊断。共有254名新患者（217名女性，37名男性，年龄中位数[四分位间距]为61[46 - 72]岁）因疑似肢体淋巴水肿于2015年1月至3月被转诊至一个专门的淋巴水肿科室进行首次会诊并被纳入研究；在118例上肢受累患者中，100例（84.7%）被诊断为乳腺癌治疗后淋巴水肿，4例为原发性淋巴水肿；在136例下肢受累患者中，31例（22.8%）被诊断为原发性淋巴水肿，35例（25.7%）为癌症后淋巴水肿。主要的其他诊断包括：32例（45.7%）脂肪性水肿/脂肪 - 淋巴水肿和21例（30%）慢性静脉功能不全。原发性、癌症后淋巴水肿及其他诊断患者在症状出现时的年龄、体重指数、转诊来源以及首次症状至专科会诊的间隔时间有所不同。在整个队列中，57例（22.4%）发生了蜂窝织炎。对于所有135例（53.1%）上肢或下肢癌症后淋巴水肿患者及119例（46.9%）其他患者，首次症状至专科会诊的中位数（四分位间距）分别为1.4（0.7 - 3.8）年和4（1.1 - 18.8）年（p < 0.0001）。专科会诊确认了原发性和癌症后淋巴水肿的诊断，并识别出其他疾病，尤其是对于疑似下肢淋巴水肿的患者。
