İlker MATARACI, Murat SARGIN, Cengiz BOLCAL, Hikmet İYEM, Suat DOĞANCI, H. Tankut AKAY, Bilgehan SAVAŞ, Harun TATAR

Alt ekstremitede lenfödem sıklığı ve etkili faktörler

Amaç: Bacaklarda ağrı ve şişlik yakınmasıyla başvuran hastalarda primer ve sekonder lenfödem oranı, sekonder lenfödeme etkili faktörler ve venöz yetmezlikle beraberliği retrospektif olarak araştırıldı.Çalışma planı: Çalışmaya alt ekstremitesinde 5 cm ve üstünde çap farkı ve belirgin ödemi olan 224 hasta (136 erkek, 88 kadın; ort. yaş 24±6.2; dağılım 20-51) alındı. Tüm hastalarda lenfödem dereceleri, ciltte renk değişikliği bulguları, enfeksiyon, travma ve malignite nedeniyle lenfadenektomi ve/veya radyoterapi uygulanma öyküleri ile yakınmaların başlama yaşı değerlendirildi.Bulgular: Hastaların %9.8'inde iki taraflı, %90.2'sinde tek taraflı lenfödem vardı. İki taraflı lenfödem bulunan hastaların sekizi primer, dokuzu sekonder, üçü idiyopatik ve ikisi Klippel-Trenaunay sendromluydu. Tek taraflı lenfödem bulunan hastaların %14'ü primer, %72'si sekonder, %3.6'sı idiyopatikti, %7.2'sinde mikst tip hastalık ve %3.2'sinde Klippel-Trenaunay sendromu vardı. Selülit, lenfanjit, cerrahi girişim, travma ve inguinal bölgeye malignite nedeniyle lenfadenektomi ve/veya radyoterapi yapılması, uygulanan univaryans analizde sekonder lenfödem gelişimi için anlamlı bulunurken, multivaryans analizde selülit, lenfanjit ve inguinal bölgeye malignite nedeniyle lenfadenektomi ve/veya radyoterapi yapılması anlamlı bulundu.Sonuç: Tekrarlayan enfeksiyonlar özellikle yatkınlığı olan hastalarda kalıcı lenfödeme neden olmaktadır. Ayrıca neoplazi nedeniyle inguinal bölge lenf metastazı sonrası yapılan lenfadenektomi ve bu bölgeye uygulanan radyoterapi kalıcı lenfödeme neden olmaktadır.

The incidence and factors influencing lymphedema in lower extremities

Background: The incidence of primary and secondary lymphedema, factors influencing secondary lymphedema and concomitance with venous insufficiency were retrospectively evaluated in patient with pain and swelling in the legs.Methods: A total of 224 patients (136 males, 88 females; mean age 24±6.2 years; range 20 to 51 years) with a ≥5 cm circumference difference in the lower limb were included the study. Grade of lymphedema, skin color changes, history of lympadenectomy and/or radiotherapy due to infection, trauma or malignancy and the starting time of their complaints were evaluated.Results: Among all the patients, 9.8% had bilateral, and 90.2% had unilateral lymphedema. Among patients with bilateral lymphedema, 8 were of primary, and 9 of secondary type, 3 cases were idiopathic and 2 patients had Klippel- Trenaunay syndrome. In unilateral lymphedema, 14% were primary, 72% were secondary, 3.6% were idiopathic, 7.2% were mixed type and 3.2% had Klippel-Trenaunay syndrome. Univariate analysis revealed that cellulites, lymphangitis, previous surgical intervention, trauma and lympadenectomy and/or radiotherapy of the inguinal region for malignancy were significant factors for secondary lymphedema. Multivariate analysis demonstrated that cellulites, lymphangitis and lympadenectomy and/or radiotherapy of the inguinal region for malignancy were significant factors.Conclusion: Recurrent infections can cause permanent lymphedema particularly in susceptible patients. Moreover, lympadenectomy for neoplasms with lymph node metastasis and radiotherapy of the inguinal region are also causes of permanent lymphedema.

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