Obstructive Lymphoedema of the Extremity due to Tumor Compression: Is It Reversible?-A Case Report

腫瘤壓迫造成的阻塞性下肢淋巴水腫：是否可以恢復？－病例報告

林士隆(Shr-Lung Lin) ； 蔡穎瀚(Ying-Han Tsai) ； 賴幸光(Hsing-Kuang Lai) ； 馮冠明(Guan-Ming Feng) ； Stefano Spanio ； 劉奕添(Yi-Tien Liu) ； 陳宏基(Hung-Chi Chen)

《中華民國整形外科醫學會雜誌》 15卷4期 (2006/12) Pp. 410-414

https://doi.org/10.7096/JPSA.200612.0410

摘要

肢體的淋巴水腫造成病患非常大的問題。大多數內科醫師和婦科醫師總是認為那些病患應該試著去承受這個痛苦。因為它是一個無法治療、不能治癒的疾病。在一些外科醫師中也有一個概念是認為淋巴水腫治療的結果總是糟糕的，並且不值得為這些病患去嘗試一些治療。不過，在最近的十年，由於麻醉學，整形外科和物理治療有很多改進，所以預後在某些病患裡完全不同。有兩種病患應該鼓勵他們去接受外科的治療。第一種是淋巴水腫病患在慢性發炎而有一些腔室形成之前。第二種是由於腫瘤阻塞而造成短期淋巴水腫的病人，可以經由腫瘤切除而改善。這裡我們報告一個病例。在他的右大腿內側有一個脂肪肌肉瘤並且在他的右下肢導致淋巴水腫。然後我們做廣泛腫瘤切除。右下肢的淋巴水腫在手術後逐漸改善並且皮膚變軟。不再有蜂窩性組織炎的發生。但是，病人需要很長的物理治療來恢復下肢的功能因為我們切除了腫瘤侵犯到的肌肉。我們的結論為當有慢性纖維變性導致腔室形成之後，淋巴水腫是不可逆的。在纖維變性發生之前的淋巴水腫能在移除堵塞的腫瘤之後可以改善。

並列摘要

The lymphoedema of extremities is very disabling to the patients. Most physicians and gynecologists always think that the patients should tolerate the miserable condition because it is ”untreatable' and ”incurable”. A concept prevalent among the surgeons is that the result of surgery for lymphoedema is always poor and is not worthwhile trying for these patients. However, in the recent decade, there is a great deal of improvement in anesthesiology, plastic surgery and physiotherapy so that the result can be totally different in selected patients. There are two kinds of patients in whom surgical intervention should be encouraged. The first category is those patients with the condition of lymphoedema before compartment formation. The second is short-term lymphoedema due to obstruction by the tumor compressed which can be removed. An example is demonstrated. The case had a liposarcoma at his right medial thigh and resulted in lymphoedema at his right lower limb. Then we performed wide excision of the sarcoma as well as the adductor brevis and longus muscles where the tumor was located. The lymphoedema of the right lower limb gradually subsided with softening of the skin after operation. There was no more attacks of cellulitis. However, prolonged physiotherapy was necessary to bring back the lower limb functions due to resection of a major muscle where the tumor was located. We make a conclusion that when there is severe chronic fibrosis causing compartment formation, the lymphoedema is irreversible. Before the development of fibrosis the lymphoedema can be solved after removal of the obstructing tumor.

並列關鍵字

soft tissue sarcoma ； lymphoedema ； compartment formation ； fibrosis