Lee Dong Gyu, Lee Soyoung, Kim Kyoung Tae
Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, Daegu, Korea.
Department of Rehabilitation Medicine, Keimyung University School of Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea.
Lymphat Res Biol. 2022 Oct;20(5):488-495. doi: 10.1089/lrb.2021.0069. Epub 2022 Jan 10.
Lymphedema produces protein-rich fluids that aggravate inflammation in the skin and subcutaneous tissue. Inflammation then induces fibroadipose tissue deposition and fibrosis. However, few methods have been developed to evaluate the severity of fibrosis. Therefore, we aimed to evaluate the subcutaneous fibrotic changes in lower extremity lymphedema following gynecologic cancer surgery using an image analysis tool, the FIJI software. Seventy-four patients with lymphedema following gynecologic surgery were enrolled in this study. We quantitatively analyzed the cross-sectional area (CSA) of soft tissue compartments, including subcutaneous tissue with the skin, muscle volume, fibrotic changes in subcutaneous tissue, and the perimeter of skin boundaries. The limb circumference and the CSA of the subcutaneous tissue and skin on the affected side were significantly larger than those on the unaffected side. Fibrotic changes showed the same trend. However, muscle volume patterns were different from those of the other compartments. Some patients showed lower muscle volume on the unaffected side than on the affected side. Circumference and cellulitis significantly affected the extent of fibrotic changes in the skin and subcutaneous tissues. Age and duration of lymphedema did not affect fibrosis. Fibrosis of subcutaneous regions with the skin can be quantitatively calculated using an image analysis tool in lower extremity lymphedema following gynecologic cancer surgery. Edema and cellulitis increase fibrotic changes in the subcutaneous tissue with the skin.
淋巴水肿会产生富含蛋白质的液体，加重皮肤和皮下组织的炎症。炎症继而引发纤维脂肪组织沉积和纤维化。然而，目前很少有方法可用于评估纤维化的严重程度。因此，我们旨在使用图像分析工具FIJI软件评估妇科癌症手术后下肢淋巴水肿患者的皮下纤维化变化。本研究纳入了74例妇科手术后发生淋巴水肿的患者。我们定量分析了软组织各部分的横截面积（CSA），包括皮肤与皮下组织、肌肉体积、皮下组织的纤维化变化以及皮肤边界周长。患侧肢体的周长以及皮下组织和皮肤的CSA显著大于未患侧。纤维化变化呈现相同趋势。然而，肌肉体积模式与其他部分不同。一些患者未患侧的肌肉体积低于患侧。周长和蜂窝织炎显著影响皮肤和皮下组织的纤维化变化程度。年龄和淋巴水肿持续时间不影响纤维化。使用图像分析工具可定量计算妇科癌症手术后下肢淋巴水肿患者皮肤与皮下区域的纤维化情况。水肿和蜂窝织炎会增加皮肤与皮下组织的纤维化变化。
