Barbieux R, Roman M M, Penafuerte D R Y, Leduc O, Leduc A, Bourgeois P, Provyn S
Departments of Nuclear Medicine and Multi-Disciplinary Clinic Unit of Lymphology, Institut Jules Bordet, Université Libre de Bruxelles, Belgium.
Department of Mammo-Pelvic Surgery, Institut Jules Bordet, Université Libre de Bruxelles, Belgium.
Lymphology. 2022;55(4):155-166.
The purpose of this study was to lymphoscintigraphically assess the effect of skin mobilization, nonspecific massage, and manual lymphatic drainage (MLD) on the root of the lower limb in patients with lower limb lymphedema. Lower limb root lymphoscintigraphical exams of 80 patients with lower limb lymphedema were analyzed. All patients underwent our stand 3 phase protocol and then were subjected to the 4th phase which included 3 subphases. Images were taken directly after the injection (subphase 1), after pinching and stretching the injection site (subphase 2), after nonspecific massage was applied to the injected site (subphase 3) and after manual lymphatic drainage of the injected site (subphase 4). The number of opened lymphatic pathways was analyzed and compared after and between each subphase (SP). SP 1 displayed open lymphatic pathways in 22 of the 80 cases (27.5%). SP 2 displayed newly opened lymphatic pathways in 48 of the 80 cases (60.0%). SP 3 displayed newly opened lymphatic pathways in 57 of the 80 cases (71.3%). Only 9 of these 57 cases did not show improvement following the next SP. SP 4 displayed newly opened lymphatic pathways in 60 of the 80 cases (75.1%). MLD improved the visualization of the lymphatic pathways in 48 cases (60%) compared to phase 3. MLD was the only technique to allow visualization of the lymphatic drainage at the level of the root of the edematous limb in 6 cases (7.5%). Physical therapy leads to a greater number of lymphatic collaterals opening in a region where no other complex decongestive therapy technique can be applied.
本研究的目的是通过淋巴闪烁造影术评估皮肤松动术、非特异性按摩和手法淋巴引流（MLD）对下肢淋巴水肿患者下肢根部的影响。分析了80例下肢淋巴水肿患者的下肢根部淋巴闪烁造影检查结果。所有患者均接受我们的标准3期方案，然后进入第4期，该期包括3个亚期。在注射后（亚期1）、捏压和拉伸注射部位后（亚期2）、对注射部位进行非特异性按摩后（亚期3）以及对注射部位进行手法淋巴引流后（亚期4）直接采集图像。分析并比较每个亚期（SP）前后及各亚期之间开放的淋巴管数量。亚期1显示80例中有22例（27.5%）有开放的淋巴管。亚期2显示80例中有48例（60.0%）有新开放的淋巴管。亚期3显示80例中有57例（71.3%）有新开放的淋巴管。这57例中只有9例在下一个亚期后未显示改善。亚期4显示80例中有60例（75.1%）有新开放的淋巴管。与第3期相比，MLD使48例（60%）患者的淋巴管显影得到改善。MLD是唯一能使6例（7.5%）水肿肢体根部水平的淋巴引流显影的技术。物理治疗能使在无法应用其他复杂消肿治疗技术的区域开放更多的淋巴侧支。
