Wang He-Jun, He Qing-Qing, Liu Chang-Rui, Wang Ying-Ying, Liu Xun-Wei
Department of Thyroid and Breast Surgery, The 960 Hospital of People's Liberation Army, Jinan 250000, Shandong Province, China.
Department of Oncology, The 960 Hospital of People's Liberation Army, Jinan 250000, Shandong Province, China.
World J Clin Cases. 2024 Aug 6;12(22):5159-5167. doi: 10.12998/wjcc.v12.i22.5159.
Lower extremity lymphedema is a common complication following treatment for gynecological malignancies. Its incidence rate can reach up to 70%, affecting ~20 million people worldwide. However, specialized treatment centers are scarce, and there is a lack of consensus on treatment approaches. Furthermore, there are even fewer reports on the systematic and effective treatment of severe lymphedema with malformations. Effective management of this condition remains a significant challenge for clinicians.
A 40-year-old woman developed bilateral leg swelling 6 years after receiving treatment for endometrial cancer. Since August 2018, she experienced > 30 episodes of lymphangitis. Upon presentation, she exhibited bilateral leg swelling and deformation, with four large swellings in the posterior thigh that impeded movement, and pain in the limbs. Skin manifestations included lichenoid lesions and features of deep sclerosis. Radionuclide lymphoscintigraphy confirmed the diagnosis of lower limb lymphedema. After 6 mo of complex decongestive therapy (CDT) and three lymphaticovenous anastomosis (LVA) treatments, the patient lost 49 kg in weight. She also experienced a maximum circumference reduction of 35.2 cm in the left lower limb and 37.5 cm in the right lower limb. The leg pain disappeared, her swelling significantly decreased, and she regained the ability to walk, cycle, and run normally.
The combined application of CDT and LVA therapy demonstrates significant positive effects in the treatment of severe, deformed stage III lymphedema.
下肢淋巴水肿是妇科恶性肿瘤治疗后的常见并发症。其发病率可达70%，全球约有2000万人受影响。然而，专门的治疗中心稀缺，且治疗方法缺乏共识。此外，关于严重畸形性淋巴水肿的系统有效治疗的报道更少。有效管理这种疾病对临床医生来说仍然是一项重大挑战。
一名40岁女性在接受子宫内膜癌治疗6年后出现双侧腿部肿胀。自2018年8月以来，她经历了30多次淋巴管炎发作。就诊时，她表现为双侧腿部肿胀和变形，大腿后部有四个大肿块妨碍活动，肢体疼痛。皮肤表现包括苔藓样病变和深部硬化特征。放射性核素淋巴闪烁造影确诊为下肢淋巴水肿。经过6个月的综合消肿治疗（CDT）和三次淋巴静脉吻合术（LVA）治疗后，患者体重减轻了49千克。她的左下肢最大周长减少了35.2厘米，右下肢减少了37.5厘米。腿部疼痛消失，肿胀明显减轻，她恢复了正常行走、骑自行车和跑步的能力。
CDT和LVA疗法联合应用在治疗严重的、畸形的III期淋巴水肿方面显示出显著的积极效果。
