Department of Dermatology, Erasmus MC, Rotterdam, The Netherlands.
Polikliniek de Blaak, Rotterdam, The Netherlands.
Phlebology. 2020 May;35(4):231-236. doi: 10.1177/0268355519885217. Epub 2019 Nov 1.
Lymphatic insufficiency might play a significant role in the pathophysiology of lipoedema. Liposuction is up to now the best treatment. As liposuction is invasive, the technique could destruct parts of the lymphatic system and by this aggravate the lymphatic component and/or induce lymphoedema. We investigated the function of the lymphatic system in lipoedema patients before and after tumescent liposuction and thus whether tumescent liposuction can be regarded as a safe treatment.
Lymphoscintigraphy was performed to quantify the lymph outflow of 117 lipoedema patients. Mean clearance percentages of radioactive protein loaded after 1 min with respect to the total injected dose and corrected for decay of the radiopharmaceutical in the subcutaneous lymphatics were used as functional quantitative parameters as well as the clearance percentages and inguinal uptake 2 h post injection. The results of lymphatic function in lipoedema patients were compared with values obtained from normal healthy volunteers. We also compared 50 lymphoscintigraphies out of the previous 117 lipoedema patients before and six months after tumescent liposuction.
In 117 lipoedema patients clearance 2 h post injection in the right and left foot was disturbed in 79.5 and 87.2% respectively. The inguinal uptake 2 h post injection in the right and left groin was disturbed in 60.3 and 64.7% respectively. In 50 lipoedema patients mean clearance and inguinal uptake after tumescent liposuction were slightly improved, 0.01 (p = 0.37) versus 0.02 (p = 0.02), respectively. This is statistically not relevant in clearance.
Lipoedema legs have a delayed lymph transport. Tumescent liposuction does not diminish the lymphatic function in lipoedema patients, thus tumescent liposuction can be regarded as a safe treatment.
淋巴功能不全可能在脂肪水肿的病理生理学中起重要作用。抽脂术是迄今为止最好的治疗方法。由于抽脂术具有侵入性，因此该技术可能会破坏部分淋巴系统，并由此加重淋巴成分和/或引发淋巴水肿。我们在脂肪水肿患者进行肿胀性吸脂术前后研究了淋巴系统的功能，从而确定肿胀性吸脂术是否可以视为一种安全的治疗方法。
对 117 例脂肪水肿患者进行淋巴闪烁显像术以定量测量淋巴流出。放射性蛋白在 1 分钟后清除的百分比，相对于总注入剂量，以及放射性药物在皮下淋巴管中的衰减进行校正，用作功能定量参数，以及清除百分比和注射后 2 小时腹股沟摄取。将脂肪水肿患者的淋巴功能结果与正常健康志愿者的数值进行比较。我们还比较了肿胀性吸脂术前后的 117 例脂肪水肿患者中的 50 例淋巴闪烁显像术。
在 117 例脂肪水肿患者中，右足和左足的 2 小时注射清除率分别受到 79.5%和 87.2%的干扰。右腹股沟和左腹股沟的 2 小时腹股沟摄取在右腹股沟和左腹股沟分别受到 60.3%和 64.7%的干扰。在 50 例脂肪水肿患者中，肿胀性吸脂术后平均清除率和腹股沟摄取量略有改善，分别为 0.01（p=0.37）和 0.02（p=0.02）。这在清除率方面没有统计学意义。
脂肪水肿腿的淋巴转运延迟。肿胀性吸脂术不会降低脂肪水肿患者的淋巴功能，因此肿胀性吸脂术可以视为一种安全的治疗方法。
