治疗淋巴水肿

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1、Recognizing Lymphedema Is Vital in Assisting Oncology Patients 认识淋巴水肿有助于肿瘤患者治疗January 21, 2009 Oncologists who are alert to the signs and symptoms of cancer and cancer-treatment-related lymphedema can have a large impact on its course, because the chronic condition can be minimized if recognized and

2、 treated early, according to a review article on lymphedema published in the January/February issue of CA: A Cancer Journal for Clinicians.依照 2009 年 1 月 21 日发布在临床癌症杂志 1/2 月刊上对于淋巴水肿的一篇回首性文章， 提示肿瘤专家警惕癌症和癌症治疗有关的淋巴水肿的体征和症状能够影响癌症的进度， 因为假如 尽早的认识和治疗，这类慢性过程能够最小化。However , oncologists are generally too busy

3、to oversee the care of lymphedema themselves, and hence should become familiar with resources that can help connect patients with lymphedema-management specialists, said lead author Brian D. Lawenda, MD, clinical director of radiation oncology at the Naval Medical Center, in San Diego, California.这篇

4、文章的第一作者 加利福尼亚圣地亚哥海军医疗中心放疗主任 Brian D. Lawenda 博士说：“肿瘤专家常常因为过于繁忙而忽略淋巴水肿的治疗，所以应当帮助病人联系办理淋巴水肿的 专家。 ”We dont have the time to manage the care for lymphedema. Therefore, my colleagues and I recommend that clinicians be aware of referring specialists in their area who are experts in the diagnosis and manag

5、ement of lymphedema, Dr . Lawenda said in an interview with Medscape Oncology 。Lawenda 博士在肿瘤学医学网景的一次采访中说： “我们没有时间去办理淋巴水肿。所以，我同 事和我建议临床医生要意识到向擅长诊疗和办理淋巴水肿的专家咨询。 ”Dr. Lawenda also noted that oncology patients at risk for lymphedema should receive pretreatment evaluation that includes baseline girth and

6、 volume measurements of limbs. He emphasized the importance of prevention education, which includes a discussion of risk factors, and arm and leg care guidelines.Lawenda 博士同时也提到存在发生淋巴水肿危险的肿瘤患者应当进行包含淋巴的基线长度和测 量体积的治疗前评估。他重申治疗前评估的重要性，包含风险要素的议论和四肢的护理指导。Pretreatment patient evaluation and education are n

7、ot well used by clinicians, suggested Dr.LawendaLawenda 博士谈来临床并无很好的对患者进行治疗前和教育。Oncology patients are left with a lot of side effects of treatment. We commonly see lymphedema, but unfortunately it does not get a lot of discussion by oncologists. As result, it can be a surprise to patients, he said.他说

8、： “肿瘤患者的治疗会遗留好多副作用。我们往常会看到淋巴水肿，但不幸的是它未获得肿 瘤专家的大批议论。所以，对于病人这会成为一个不测。 ”Whos Most at Risk?谁是最危险的呢？hisThe most common causes of lymphedema in the United States are surgery and radiation therapy for the treatment of cancer. The most common etiology is the impaired flow of lymphfluid through the draining

9、lymphatic vessels and lymph nodes, write Dr. Lawenda and coauthors, Tammy Mondry, DPT , a physical therapist at New Horizons Physical Therapy, in San Diego, and an expert on managing the condition, and Peter Johnstone, MD, chair of the Department of Radiation Oncology at the Indiana University Schoo

10、l of Medicine, in Indianapolis.在美国造成淋巴水肿的最常有的原由是癌症治疗中的外科手术和放疗。 Lawenda 博士和其余作 者 圣地亚哥新视线物理治疗机构的物理治疗师 Tammy Mondry 和印第安纳波利斯的印第安 纳大学医学院放疗系主任 Peter Johnstone 博士 以为最常有的病因是淋巴管和淋奉承分泌的 淋巴液的通路被伤害了。Lymphedema is most commonly reported after breast cancer treatment, but can result from the treatment of cervica

11、l, endometrial, vulvar , head and neck, and prostate cancers, and of sarcomas and melanoma. Lack of standardized definitions and measurement techniques for the disorder make an accurate incidence rate of cancer-treatment-related lymphedema difficult to determine, say the authors.淋巴水肿最常有于胸部肿瘤治疗后，但也可见

12、于颈部、子宫内膜、 外阴、 头颈和前列腺等部位的癌症以 及瘤子和黑素瘤治疗后。 作者们以为针对这类状况因为缺少规范定义和办理技术致使癌症 治疗后有关的淋巴水肿的精准发生率难以确立。However , the likelihood of lymphedema by cancer type and related treatment has been established 可是，可能致使淋巴水肿的癌症种类和有关治疗已经成立。For instance, with regard to breast cancer, the frequency of breast edema ranges from 6

13、% to48% when surgery and radiation therapy are combined. The frequencies tend to be at higher ends ofthethe range when a lymph node dissection and radiation therapy are performed.比如像胸部肿瘤，假如归并手术和放疗，胸部水肿的概率从 6% 到 48% ，假如切除一个淋奉承 同时放疗，水肿的发生率将会处于上述范围的高端。Increased body mass index and tumor location in the

14、 upper outer quadrant are other factors that have been reported to significantly increase the risk for breast lymphedema. Also, one study (Lymphat Res Biol. 2005;3:208-217) found that women older than 60 years had a higher likelihood of lymphedema (41.2%) than women younger than 60 years (30.6%). Ap

15、proximately 15% of patients with a bra cup size of A or B developed breast edema, whereas approximately 48% of patients with a bra cup size of C, D, or DD presented with edema.已报导的可显然增添发生胸部淋巴水肿危险的要素还包含较高的体重指数以及肿瘤的生长地点 在外上象限。此外一项研究( 淋巴生物研究杂志， 2005;3:208-217 )也表示 60 岁以上的妇 女发生淋巴水肿的几率 (41.2%)高于60岁以下的妇女(

16、30.6%)。胸罩罩杯为A或B的病人发生淋巴水肿的几率大概为 15% ，而胸罩罩杯为 C、 D 或 DD 的病人发生几率为 48% 。In general, patients tend to be at highest risk for cancer-treatment-related lymphedema when a large number of lymph nodes are removed, radiation and surgery are combined as treatment, or an infection in a limb that has been operated

17、 on develops, said Dr. Lawenda.Lawenda 博士说： “一般来说，手术与放疗联合，并且大批的淋奉承被切除或许手术后的肢体感 染扩散都会使病人高发与癌症治疗有关的淋巴水肿 ”Recognizing Lymphedema 认识淋巴水肿The signs and symptoms of lymphedema include, in a limb, a feeling of heaviness or tightness, aching or discomfort, restricted range of motion, and swelling (partial or

18、 total). Swelling might also occur in the adjacent upper quadrant of the trunk.淋巴水肿的症状和体征包含肢体感觉深重或紧绷，痛苦或不适， 制动， 并且肿胀(部分或所有) 肿胀可能会发生在邻近上象限的躯体部分。Lymphedema patients usually do not have severe pain, and skin color and temperature are generally normal. The swelling is typically unilateral and can includ

19、e the dorsum of the hand or foot. A deepening of the natural skin folds can occur .淋巴水肿的病人往常没有很严重的痛苦， 皮色和皮温一般也是正常的。 肿胀一般为单侧并包含手 背和足背。皮肤的自然褶皱可能加深。Patients can also present with a Stemmer sign, in which the skin of the dorsum of the fingers and toes cannot be lifted or can only be lifted with difficul

20、ty.病人表现为 Stemmer 征阳性，即手指和脚趾背部的皮肤不可以提起或许只好很困难的提起。 Evaluation for the condition should involve a close inspection of the skin, a gauging of pain level, and a review for the Stemmer sign. Photography and measurements of limb girth and volume are recommended, if possible. Generally, when a limb volume h

21、as increased by 10%, lymphedema is likely present, note the authors.状况的评估应当包含皮肤的严格检查，痛苦水平的丈量， Stemmer 征的检查。假如可能的话拍 摄和丈量淋巴的尺寸和体积并记录。 作者提示一般淋巴体积增添 10% ，淋巴水肿就有可能出现。 Lymphedema is considered reversible if a patient presents with very soft pitting edema with no fibrosis, write the authors. Prolonged elev

22、ation will leadto a complete resolutionof theswelling. Nevertheless, lymphedema is not curable and will require treatment and ongoing care in all cases.作者以为假如患者表现为轻度凹陷性水肿不伴有纤维症时， 淋巴水肿是 “可逆的 ”。连续抬高患肢 能够完整除去肿胀，淋巴水肿不是不行治愈的，这需要治疗和连续的护理。As lymphedema progresses, the outcomes from any treatment are less o

23、ptimal because of adipose and fibrotic changes within the tissue. Furthermore, infections become more common, as do fibrosis and other skin changes, such as papillomas, cysts, fistulas, and hyperkeratosis.假如淋巴水肿连续进展，因为组织内的脂肪和纤维化改变，那么任何治疗的结果都不是乐观的。 并且当纤维和其余皮肤改变，如乳突淋瘤、囊肿、瘘管以及角化过分，感染会更加常有。 The risk for

24、 lymphedema is lifelong, Dr. Lawenda and his colleagues emphasize. The onset canoccur at the time of treatment or decades later. In any case, an examination must rule outrecurrent or metastatic disease causing tumor blockage of the lymphatic system and deep vein thrombosis.Lawenda 博士和他的同事重申说淋巴水肿的危险是

25、平生的。这类隐患能够在治疗时发生，也可 能是几十年此后发生。 不论怎样， 一定清除循环或代谢疾病致使的肿瘤阻挡淋巴系统和深静脉血 栓的形成。Managing Lymphedema淋巴水肿的办理Once lymphedema is diagnosed, treatment should begin immediately. The goal of treatment is to decrease the excess limb volume as much as possible and to maintain the limb at its smallest size. This reduce

26、s the amount of stagnant fluid in the tissues, thereby potentially preventing or eliminating infections. The first step in treatment is referral to a physical therapist, note the authors, to quantify the amount of edema in the limb and establish a baseline.淋巴水肿一经诊疗， 应当立刻予以治疗。 治疗的目的是尽可能的减小过大的淋巴体积， 使它

27、保持 在最小的体积。 这样能够减少组织内的滞留液体， 能够潜伏的预防和阻挡感染。 作者指出治疗的 第一步是安排一个理疗专家去量化淋巴水肿的数目，而后成立一个基线。The gold-standard treatment for lymphedema is complete decongestive therapy, say the authors, which consists of a treatment and maintenance phase; the latter is life-long and principally involves self-care that includes

28、 skin care, wearing a compression garment, and exercise. Other nonsurgical treatments are manual lymph drainage and compression.作者以为淋巴水肿的金标准治疗方法是可降低充血的治疗， 包含治疗期和保持期。 保持期是平生 的，主要包含皮肤护理、 穿压缩衣服 和锻炼等自我护理的内容。 其余非外科治疗是手动压缩和引流淋 巴。Low-level laser therapy and microsurgical lymphatic-venous anastomoses can al

29、so be effective treatment, say the authors.作者以为低水平的激光治疗和显微外科淋巴静脉符合术也是有效的治疗方法。The challenge for the patient and oncologist is to find reputable healthcare providers who are certified in caring for the condition and can help make treatment decisions and deliver care, said Dr. Lawenda. In their article

30、, the authors list several nonprofit organizations with lymphedema expertise that can provide help in connecting patients with caregivers. The organizations include the American Cancer Society, the Circle of Hope Lymphedema Foundation, the Lymphedema Research Foundation, the Lymphology Association o

31、f North America, and the National Lymphedema Network.Lawenda 博士以为病人和肿瘤专家面对的挑战是找到 “好的 ”保健供给者 有资质照料病人，可 以帮助拟订治疗计划并予以帮助。 在文章中， 作者排列了拥有淋巴水肿方面专业知识能够向病人 供给帮助的非盈余组织的名单。 这些组织包含美国癌症协会， 淋巴水肿希望基金会， 淋巴水肿研 究基金会，北美淋巴学联合会以及国际淋巴水肿网络。The researchers have disclosed no relevant financial relationships. 研究者已公然表示不存在有关的财务联系CA Cancer J Clin. 2009;59:8-24. Abstract临床癌症杂志 ， 2009;59:8-24 ，纲要