Reich-Schupke S, Mohren E, Stücker M
Venenzentrum der Dermatologischen und Gefäßchirurgischen Kliniken, Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland.
Hautarzt. 2018 Jun;69(6):471-477. doi: 10.1007/s00105-018-4151-4.
Implementation of guideline recommendations for the diagnosis and therapy of lipedema and lymphedema seems to be problematic in daily routine. Systematic data for Germany are missing. The aim of the study was data collection regarding diagnosis and therapy of lymphologic diseases in an outpatient setting.
Monocentric, prospective survey of patients from a lymphologic outpatient clinic using a standardized questionnaire focusing on diagnostics and therapy at the initial diagnosis.
In all, 72 patients (83.3% women) with lymphedema (n = 26), lipedema (n = 14) or lipolymphedema (n = 32) were included; 44.4% had symptoms more than 5 years before the initial diagnosis. Main symptoms were swelling of the leg and foot (especially lymphedema) and feeling of heaviness (especially lipedema). In 75%, the initial diagnosis was made by a medical specialist. The basic diagnostics recommended by the guidelines-medical history (73.6%) and clinical examination (84.7%)-were done in most of the patients. After the initial diagnosis, 46% of the patients had decongestion therapy of different intensity and quality. A total of 58.3% of the patients were directly provided a prescription for a medical stocking. Only a few patients received instructions for breathing exercises (22.2%), self-performed lymphatic drainage (6.9%) or muscle exercises (8.3%).
There are still deficits in the diagnosis and especially in the therapy of patients with lymphologic diseases in an outpatient setting. Further education and training are necessary for physicians, physiotherapists, medical supply businesses, and patients.
在日常医疗中，脂性水肿和淋巴水肿的诊断与治疗指南建议的实施似乎存在问题。德国缺乏系统性数据。本研究的目的是收集门诊环境下淋巴系统疾病的诊断和治疗数据。
采用标准化问卷，对一家淋巴门诊的患者进行单中心前瞻性调查，重点关注初诊时的诊断和治疗情况。
共纳入72例患者（83.3%为女性），其中淋巴水肿患者26例，脂性水肿患者14例，脂肪淋巴水肿患者32例；44.4%的患者在初诊前症状持续超过5年。主要症状为腿部和足部肿胀（尤其是淋巴水肿）以及沉重感（尤其是脂性水肿）。75%的患者由医学专家做出初诊诊断。大多数患者进行了指南推荐的基本诊断——病史采集（73.6%）和临床检查（84.7%）。初诊后，46%的患者接受了不同强度和质量的消肿治疗。共有58.3%的患者直接获得了医用弹力袜的处方。只有少数患者接受了呼吸练习指导（22.2%）、自我淋巴引流指导（6.9%）或肌肉锻炼指导（8.3%）。
门诊环境下淋巴系统疾病患者的诊断，尤其是治疗仍存在不足。医生、物理治疗师、医疗用品企业和患者都需要进一步的教育和培训。
