Bollinger A
Schweiz Med Wochenschr. 1985 Jun 15;115(24):836-43.
Present knowledge on primary and secondary lymphedema of the extremities is reviewed. Conventional lymphography with contrast media requires surgical cannulation of pedal lymphatics and is indicated only in a few specific situations. Clinical findings, results of the patent blue test and possibly fluorescence microlymphography with fluorescent dextrans, indirect lymphography with iotasul, or isotope studies, suffice for correct diagnosis. In hereditary lymphedema present at birth (Milroy's disease) the lymphatic capillaries and precollectors are aplastic, whereas in sporadic lymphedema with postpubertal onset the large collectors are hypoplastic or aplastic. Conventional lymphography still yields the best results in differentiating between primary lymphedema with aplasia of the aorto-iliac collectors and a secondary form due to neoplastic disease. Combined physical therapy with tight bandages and stockings, massage and use of pneumatic devices for intermittent compression considerably reduces the edema and renders surgery unnecessary in most patients. Diuretics have a beneficial effect during early management, and benzopyrones for longterm treatment.
本文综述了目前关于四肢原发性和继发性淋巴水肿的知识。传统的造影剂淋巴造影需要对足淋巴管进行手术插管，仅在少数特定情况下适用。临床检查结果、专利蓝试验结果以及可能的荧光右旋糖酐荧光微淋巴造影、碘他拉酸间接淋巴造影或同位素研究结果，足以做出正确诊断。出生时即存在的遗传性淋巴水肿（米尔罗伊病）中，淋巴毛细血管和前集合淋巴管发育不全，而青春期后发病的散发性淋巴水肿中，大集合淋巴管发育不良或发育不全。在区分主动脉-髂总集合淋巴管发育不全的原发性淋巴水肿和肿瘤性疾病所致的继发性淋巴水肿方面，传统淋巴造影仍能取得最佳效果。物理治疗结合紧身绷带和长袜、按摩以及使用气动装置进行间歇性压迫，可显著减轻水肿，使大多数患者无需进行手术。利尿剂在早期治疗中有有益作用，苯并吡喃类药物用于长期治疗。
