Istranov Andrey L, Makarov Ivan G, Makarova Natalya V, Tulina Inna, Ulasov Ilya V, Isakova Yuliya I
Department of Oncology, Radiotherapy and Reconstructive Surgery, Sechenov First Moscow State Medical University, Moscow, Russia.
Clinical-Research Center for Rehabilitation of Lymphedema Patients "LYMPHA", Moscow, Russia.
Front Surg. 2023 Apr 12;10:1048159. doi: 10.3389/fsurg.2023.1048159. eCollection 2023.
Genital lymphedema is a severe, disabling condition associated with a malfunction of the lymphatic system. Primary lymphedema of the scrotum is a variant of congenital dysplasia of lymphatic vessels. Secondary genital lymphedema is much more common and can be caused by parasitic invasion (filariasis) or damage to the lymphatic system during the treatment of cancer (radiation therapy, lymphadenectomy). Healthcare providers are frequently unable to detect and treat this illness successfully in ordinary clinical practice. This paper uses the case of a patient with stage 3 secondary lymphedema (unknown genesis) of both lower extremities and lymphedema of the scrotum, complicated by recurrent erysipelas, a history of lymphorrhoea, impaired skin trophic and multiple papillomatosis, to demonstrate the efficacy of a combination of conservative and surgical methods in the treatment of giant lymphedema of the scrotum.
In the treatment, the combination of decongestant physical therapy (CDPT, CDT) according to M. Földi was used at pre-surgery and post-surgery stages, combined with a reconstructive operation, including the removal of the affected tissues of the urogenital region, phalloplasty, and scrotoplasty with rotational skin flaps.
A decrease in the circumference of the lowest extremities in the lower leg area by 68 cm on the right and by 69 cm on the left was achieved by conservative treatment. Due to the combination of conservative and surgical treatment, the patient's body weight decreased by 69.4 kg, and the scrotum decreased by 63 cm. Subsequently, the patient fully recovered his sexual function.
A combination of complex decongestive physical therapy and surgery is necessary for patients with advanced genital edema. The isolated use of surgical or conservative treatment does not provide a sufficient improvement in the patient's quality of life. Modern plastic surgery technologies enable patients to achieve complete functional and cosmetic recovery, while proper selection and usage of compression hosiery help preserve and improve the outcomes acquired following treatment.
生殖器淋巴水肿是一种与淋巴系统功能障碍相关的严重致残性疾病。阴囊原发性淋巴水肿是淋巴管先天性发育异常的一种变体。继发性生殖器淋巴水肿更为常见，可由寄生虫感染（丝虫病）或癌症治疗期间（放射治疗、淋巴结切除术）淋巴系统受损引起。在普通临床实践中，医疗服务提供者常常无法成功检测和治疗这种疾病。本文以一名双下肢3期继发性淋巴水肿（病因不明）合并阴囊淋巴水肿的患者为例，该患者并发复发性丹毒、有淋巴漏病史、皮肤营养障碍及多发性乳头状瘤病，旨在证明保守治疗与手术方法相结合在治疗阴囊巨大淋巴水肿中的疗效。
治疗过程中，术前和术后阶段采用了根据M. 福尔迪方法进行的消肿物理治疗（CDPT、CDT），并结合重建手术，包括切除泌尿生殖区域的病变组织、阴茎成形术以及采用旋转皮瓣的阴囊成形术。
通过保守治疗，右下肢小腿最低部位周长减少了68厘米，左下肢减少了69厘米。由于保守治疗与手术治疗相结合，患者体重减轻了69.4千克，阴囊周长减少了63厘米。随后，患者性功能完全恢复。
对于晚期生殖器水肿患者，综合消肿物理治疗与手术相结合是必要的。单独使用手术或保守治疗并不能充分改善患者的生活质量。现代整形手术技术使患者能够实现完全的功能和外观恢复，而正确选择和使用压力袜有助于维持和改善治疗后取得的效果。
