, pathogenesis:
1. Primary lymphedema: caused by abnormal development of lymphatic vessels; There are three types: lymphangioplasty, lymphangiodysplasia and lymphangiohyperplasia. 2. Secondary lymphedema: normal lymphatic obstruction due to acquired reasons. Filariasis and streptococcal infections are common. After radiotherapy and lymph node dissection for cancer.
, clinical symptoms:
Lymphedema of the lower extremity is mainly manifested as swelling of one limb, starting from the ankle and then spreading to the whole lower extremity. The skin is normal in the early stage, and it is thickened, dry, rough, pigmented, with warts or spines in the later stage. Lymphedema and degree can be divided into: 1. Mild: Limb edema is concave, which can be alleviated or disappeared after raising the limb, and there is no fibrotic damage to the skin. 2. Moderate: the edema pressure is no longer depressed, the edema of the raised limbs is not obvious, and there is moderate fibrosis. 3. Severe: elephantiasis-like skin changes. Secondary lymphedema is often accompanied by recurrent lymphangitis and gradually aggravated lymphedema. When lymphangitis occurs, local swelling, pain, swollen lymph nodes and tenderness are often accompanied by sudden chills and high fever.
, diagnosis
Rest:
1. Early patients should be differentiated from deep vein thrombosis, vascular edema and arteriovenous fistula. Through the history and manifestations, the general diagnosis is relatively easy. 2. According to the typical leg-like features of lymphedema of lower limbs, the diagnosis of advanced patients is easy. 3. If the cause of lower limb swelling is unknown, auxiliary examinations can be performed, such as diagnostic puncture tissue fluid analysis, lymphangiography and isotope lymphangiography.
, auxiliary inspection:
Lymphangiography is helpful to distinguish primary lymphedema from secondary lymphedema. At the same time, the location of lymphatic obstruction can be determined. Diagnostic puncture tissue fluid analysis and isotope lymphangiography are helpful to exclude other diseases.
Recommendation: Governance
Treatment:
Non-surgical treatment: including raising the affected limb, wearing elastic socks, limiting the intake of water and salt, applying diuretics, etc.
Prevention of infection and baking binding therapy. Through repeated hot moxibustion stimulation, the tissue temperature is increased and the metabolic activity is strengthened, which can promote the regeneration of tubes and the recovery of lymphatic reflux. 2. Surgical treatment: There are four kinds of surgical treatment currently used: 1. Skin grafting: the principle is to remove the diseased tissues of the whole leg and dorsum of foot below the knee joint, including skin, subcutaneous tissue and deep fascia, and then take healthy limbs or use the cut diseased skin for skin grafting. 2. Skin flap embedding. 3. Pedicled aponeurosis transplantation. 4. Lymphatic vein anastomosis is recommended.