Lenfödem Tanı ve Tedavisine Güncel Bakış

Lenfödem, cilt ve cilt altı dokuda proteinden zengin interstisyel sıvının birikmesi ile oluşan kompleks bir durumdur. Ekstremitedeki hacimsel ve cilt dokusundaki kozmetik değişiklikler hastanın günlük yaşamını ve psikososyal durumunu olumsuz etkilemektedir ve tedavi edilmez ise ilerlemeye devam etmektedir. Lenfödem, primer ya da sekonder nedenlere bağlı olabilir. Primer lenfödemde en sık görülen anomali tipi, hipoplazik tip lenf damarlarıdır. Sekonder lenfödemin en sık tipi, gelişmiş ülkelerde meme kanseri cerrahisi sonrası görülürken gelişmekte olan ülkelerde, parazitlerdir filaryazis . Lenfödemin tanısı, evrelendirilmesi ve şiddetinin ölçülmesinde henüz altın standart bulunmamaktadır. Öykü ve muayeneden sonra, klinik pratikte en sık kullanılan teknik ultrasonografidir. Lenfödem tedavisinin ilk basamağı ekstremiteyi normal ya da normale yakın boyuta ulaştırmak ve komplikasyonları önlemektir, çünkü tedavide kür yoktur. Komplet dekonjestif terapi, lenfödem ve ilişkili durumlarda kullanılan, manuel lenf drenajı, kompresyon tedavisi, remedeal egzersizler, cilt bakımından oluşan 4 bileşenli bir tedavidir. Bu tedavi 2 fazlı olarak yapılmaktadır. Faz 1 yoğun veya dekonjestif tedavidir. Faz 2 de ise bası giysileri ve gece bandajı ile faz 1 deki kazanımları sürdürebilmesi amaçlanır. Bu dönem ömür boyu devam eder. Sonuç olarak lenfödem, izole bir tablo veya hayatı tehdit eden sistemik bir sendrom olabilir. Tanı, tedavi ve takip aşamasında multidisipliner yaklaşılmalıdır

Current Overview of The Diagnosis and Treatment of Lymphoedema

Lymphoedema is a complex condition caused by the collection of protein-rich interstitial fluid in the cutaneous and subcutaneous tissue. Cosmetic changes in cutaneous tissue and the volumetric changes of the extremity affect the daily life and psychosocial state of the patient negatively and continue to progress if not treated. Lymphedema may be the result of primary or secondary causes. The most common type of anomaly in the primary lymphedema is the hypoplasic lymphatic vessel type. The most common type of secondary lymphoedema is parasites filariasis in developing countries, while in the developed countries lymphoedema is mostly seen after breast cancer surgery. There is no gold standard yet for the diagnosis, staging, and severity of lymphoedema. After taking the patient’s’ history and physical examination, technical ultrasonography is often used firstly in clinical practice. The first step in the treatment of lymphoedema is to bring the extremity close to normal size and prevent complications hence there is no cure in the treatment. Complete decongestive therapy is a 4-component therapy consisting of manual lymph drainage, compression therapy, remedial exercises, and skin care, and is used in lymphatic and related conditions. This treatment has 2 phases. Phase 1 is intense or decongestive treatment. In Phase 2, it is aimed to sustain the gains of phase one with pressure garments and night bandages. This period lasts for life. As a result, lymphedema can be an isolated picture or a systemic syndrome that is life-threatening. A multidisciplinary approach should be performed during diagnosis, treatment, and follow-up

Keywords:

lymphoedema, manual lymph drainage lymphatic system,

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