Department of Plastic and Oral Surgery, Lymphedema Program, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Lymphat Res Biol. 2020 Dec;18(6):534-538. doi: 10.1089/lrb.2019.0086. Epub 2020 Apr 29.
Lymphedema results from inadequate lymphatic function due to failure of lymphatic development or injury to a functioning lymphatic system. Patients suffer enlargement of the affected area, psychosocial morbidity, infection, and functional disability. The purpose of this study was to characterize the disease in a cohort of patients referred to a specialized center. Our Lymphedema Program database was reviewed for all referrals between 2009 and 2019. Diagnosis was determined based on history, physical examination, and lymphoscintigraphy. Lymphedema type (primary, secondary, and obesity-induced), location of swelling, morbidity, previous management, accuracy of referral diagnosis, the geographic origin of the patients, and treatment in our center were analyzed. Seven hundred patients were referred with a diagnosis of "lymphedema"; 71% were female and 38% were children. Lymphedema was confirmed in 71% of the cohort: primary (62%), secondary (22%), and obesity-induced (16%). Twenty-nine percent of individuals labeled with "lymphedema" had another condition. One-half of patients had not received treatment, and 36% resided outside of our local referral area. One-third of subjects with lymphedema had an infection and 30% had >1 visit to the center. Patients with confirmed lymphedema were managed with compression stockings (100%), pneumatic compression (69%), and/or an excisional procedure (6%). Patients with lymphedema typically are adequately managed with conservative compression therapies and rarely require excisional operations. Diagnostic confusion is common and individuals with possible lymphedema are best managed by physicians focused on the disease.
淋巴水肿是由于淋巴系统发育不全或损伤导致的淋巴功能不足引起的。患者会出现受累区域肿大、心理社会病态、感染和功能障碍。本研究的目的是描述一个专门中心就诊的患者队列中的疾病特征。我们回顾了 2009 年至 2019 年期间所有的转介患者的淋巴水肿项目数据库。根据病史、体格检查和淋巴闪烁成像来确定诊断。分析了淋巴水肿类型（原发性、继发性和肥胖引起的）、肿胀部位、发病率、既往管理、转介诊断的准确性、患者的地理来源以及在我们中心的治疗情况。有 700 名患者被诊断为“淋巴水肿”，其中 71%为女性，38%为儿童。在队列中，71%的患者被确诊为淋巴水肿：原发性（62%）、继发性（22%）和肥胖引起的（16%）。29%的被贴上“淋巴水肿”标签的个体还有其他疾病。一半的患者未接受治疗，36%的患者居住在我们当地的转诊区域之外。三分之一的淋巴水肿患者有感染，30%的患者在中心就诊超过 1 次。确诊为淋巴水肿的患者接受了压迫性弹力袜（100%）、气动压迫（69%）和/或切除手术（6%）的治疗。患有淋巴水肿的患者通常通过保守的压缩疗法进行充分治疗，很少需要进行切除手术。诊断上的混淆很常见，对于可能患有淋巴水肿的患者，最好由专注于该疾病的医生进行管理。
