Elephantiasis can cure?
July 1st, 2009
Question
Elephantiasis can cure?
Answer
銆怬verview銆?lymphoedema lymphoedema refers to certain parts of the body back to blocked lymph soft tissue fluid caused by repeated infection in the body after subcutaneous fibrous connective tissue hyperplasia, fat hardening, if the enlargement is physically, the latter of skin thickening, rough, resilience, such as elephantiasis, also known as quot;elephantiasis.quot; 銆?銆?diagnosis. There immitis infection or history of recurrent attacks of erysipelas, or axillary, inguinal lymphadenectomy accepted and the history of radiation therapy. 2. Early limb swelling, reduce post-elevation. Late limb swelling Obviously, the surface rough diagonalization, was rubber-like swelling. A small number have cracked skin, ulcers or verrucous neoplasm. 3.Volvulus-infected persons can be found around the blood test granulosus actin. Lymphatic lymphatic imaging to determine the situation of the development or obstructed. 銆?銆怢ymphedema treatment sooner or later according to the course, the principle of different treatment. Pent-up stranded in the early to rule out lymph, lymphatic fluid to prevent the aim of regeneration, while the late recovery can not be surgically removed lesions or shunt in the treatment of limitations for the purpose of lymphatic obstruction. (A) the acute phase of lymphedema, mainly of non-surgical treatment. 1. Postural drainage down the state under the limb so that organizations stranded gap in lymph increased鎶珮鎮ｈ偄30 ~ 40cm can use gravity to promote the lymph return, byLight edema. This failure is simple and effective, but the role of non-durable, re-limb edema increase sag. 2. Compression bandaging in the basis of postural drainage, in the limb refers to things with high elastic compression stockings or elastic bandages dressing, squeeze space organization to help the lymphatic return. Stretch elastic bandage should be appropriate. Gap pressure can also be used (intermittent compression pumps) and a long time on many occasions to use to improve a certain effect edema. Reported in the literature abroad lymph pressure for the current (lymha-press) a more advanced and efficient compression of the inflatable devices, inflatable devices sub -9 ~ 12, each pneumatic compression alone, compression gradually from distal to proximal limb, and a cycle of 25 less. Shun such lymphatic pressure than other simple pressure of the pneumatic compression device significantly shortened the time (a simple cycle pressure inflatable device about 100 seconds), at the same time can generate higher pressures up to 15.6 ~ 20.8kPa (120 ~ 160mmHg) than surgery and elastic socks simply more effective in swelling. But its use of more complex organizations can not reduce the gap in the protein composition, is only applicable to the acute stage and preoperative preparations, such as short-term treatment. 3. Restricted sodium intakeAnd use of diuretics in acute phase of appropriate restrictions on intake of sodium chloride, generally 1 ~ 2g / d, in order to reduce the organization of sodium and water retention. At the same time, the use of appropriate diuretics, sodium excretion to speed up the water. Hydrochlorothiazide can be used for each urine thiophene 25mg, 3 times a day and, where appropriate, potassium supplement, to be in stable condition after the service stopped. 4. The prevention of infection by selection of anti-fungal ointment, powder, dry toes to maintain the prevention and control of fungal infection in the most effective method; toe a bed is also more common bacterial infections, should be ground cut nail means to remove dirt and reduce bacterial invasion way. When symptoms of systemic streptococcal infection when penicillin and other drugs should be used with bed restActive infection control. Lymphedema complicated by late chapped skin ointment external use skin protection and lubrication. In addition, a variety of vaccines, milk and protein injection of the opposite sex is well-established anti-infective therapy. The body#39;s various defense agencies to be boosted. Foreign scholars to prove the injection of typhoid vaccine, the output of lymphocytes in lymphatic increased blood levels of gamma globulin also increased, and prevent the occurrence of a permanent role of lymphatic obstruction. Authors speculate heterosexual protein may play a role through the pituitary and adrenal glands. (B) chronic lymphedema, including non-surgical treatment of the drying treatment and a variety of stretch surgery. 1. Bake bake tightrope stretched therapy therapy is to explore the heritage of a Chinese medicine treatment. Its treatment of the principle is the use of continuous radiant heat, so that the skin vasodilator limb, a large number of sweating, local tissue clearance of the liquid back into the blood and improve lymph circulation. Has not happened for limb lymphoedema severe skin drying hyperplasia can stretch therapy selection. An electric radiant heat treatment and oven heating methods. Temperature control in the 80 ~ 100 鈩? day 1, each 1 hour, 20 times as a course of treatment. Each treatment interval of 1 ~ 2 weeks. End of each treatment should be applied elastic bandage. The basis of clinical observation by 1 ~ 2 months after treatment shows that limbOrganization of the loose limbs gradually reduce, in particular, Erysipelas-like episodes greatly reduce or stop seizures. 2. Surgical treatment of lymphedema without the majority of surgery. About 15% of primary lymphedema of lower limb surgery ultimately line. In addition to the existing methods of amputation surgery can not cure lymphedema, but significant improvement in symptoms. 鈶?surgical indications: 鈶?limb dysfunction: fatigue as a result of heavy physical activity and joint restrictions. 鈶?excessive swelling with pain. 鈶?recurrent cellulitis and lymphangitis invalid by the medical treatment. 鈶?lymphatic sarcoma: Long-term lymphedema causes fatal malignant. 鈶?beauty: most ofThe number of patients with primary lymphedema for young women, for obvious swelling and the requestor may wish to consider cosmetic surgery, but it should be to improve the function-oriented, beauty Des country, or may be unsatisfactory therapeutic effect. Preoperative preparation and postoperative management: 鈶?preoperative preparation for surgery plays an important role in the effect. They include: 鈶犳姮楂樻偅鑲ed rest: so that limb edema decreased to a minimum. There elevate lower extremities, lower extremities and skeletal traction suspension and so on, up to 60 lower limbFlaps less chances of infection. 鈶?cleansing the skin: to achieve ulcer healing or control of the purpose of local infection. 鈶?to maintain patency after drainage; the separation of rough surface can be sustained capillary oozing. Vacuum must be placed to maintain the flap effusion of blood under the non-plot to reduce the impact of skin flap blood supply factors, to prevent the billet flap death, infection, surgery to reduce the failure rate. 鈶?after鎶珮鎮ｈ偄continue to reduce limb edema, is conducive to venous and lymphatic return. 鈶?surgery Category: lymphedema surgery can be divided into two types: 鈶?extensive resection lesions. 鈶?reconstruction of lymphatic return. According to experimental and clinical evidence, which a good part or most of the effect ofIn fact, removal of lesions in a wide range based on the progress. Simple reconstruction of the lymphatic reflux, surgical operation is fine, but have little effect. Secondary lymphoedema due to lymphatic obstruction point near the remote function of the lymphatic system in good condition, surgical reconstruction should be given back to the regional lymph good effect, on the contrary, the majority of primary lymphedema of the last distal lymphatic dysplasia, not stand up to look forward to the reconstruction of the lymphatic reflux surgery can improve symptoms. 銆?銆怢ymphedema etiology classification of the cause of the large number of both the etiology and clinical types can be broadly divided into primary and adoptive two categories. Primary lymphedema is most lymphangiectasia, valveOr absence of dysfunction, such as due to congenital dysplasia. According to lymphatic imaging, can be divided into type of primary lymphedema are as follows: 鈶?lymphatic hypoplasia, with absence of subcutaneous lymphatic; 鈶?lower lymphatic development, lymph nodes and lymphatic vessels rather than small; 鈶?lymphoid hyperplasia, lymph nodes and lymphatic vessels with large more distorted from time to time and varicose. Which is very rare lymphatic hypoplasia, common in congenital lymphedema. Development than is the most common type. Simple and are鍜恛f congenital lymphedema. Early-onset lymphoedema were more common in adolescent women or young women, increase in symptoms of menstrual period, so that the cause may be related to endocrine-related disorders, or primaryLymphedema of 85 ~ 90%. 35-year-old said after the onset of late-onset lymphedema. The majority of secondary lymphedema caused by lymphatic obstruction. Is the most common of lymphatic filariasis edema and lymphedema of streptococcal infection. Breast cancer of upper limb lymphedema after radical mastectomy is not uncommon. Although Herophilos and Aristotle as early as the third and fourth century of the lymphatic system has been observed, in modern times has done a great deal of experimental research, however, lymphedema of the exact pathogenesis is not clear. Category: (a) 1 of primary lymphedema. Congenital: simple genetic (milroy disease) 2. early-onset (b) 1 secondary lymphedema. infection: parasites, bacteria, fungi, etc. 2. injury: surgery, radiation therapy, burns, etc. 3. malignancies: the primary tumor, secondary tumor 4. other: systemic diseases, pregnancy and other pathological changes銆?銆恖ymphoid cell gap in the tissue fluid, the flow of lymphatic venous return. Lymphatic circulation is also a physiological function of the physical cycle. Congenital dysplasia of the lymphatic system or as a result of occlusion of one reason or another, or damage occurred, that is, back to their remote lymphatic obstacles occur, organizations abnormal lymph increased clearance.If there is physical involvement in the physical uniformity of the thickening, at first the skin is still smooth, soft,鎶珮鎮ｈ偄edema subsided significantly. As a result of the accumulation of lymph is rich in protein, can be as high as 5.8g/dl, 銆斻'?normal long-term stimulus to make 0.72g/dl dysplasia of connective tissue, adipose tissue to replace a large number of fibrous tissue. Extreme thickening of the skin and subcutaneous tissue, skin keratosis, rough, mean pressure does not occur after the indentation, there verruciform by biology, the formation of a typical quot;elephantiasis.quot; Infection so that an increase of inflammatory exudate to stimulate a large number of connective tissue hyperplasia, more lymphatic damage, increase the lymph stranded, an increase of secondary infectionOpportunity to form a vicious cycle, resulting in increasing lymphedema. Clinical manifestations銆?銆恈ause the light of the above categories, will be the clinical features of their own are as follows: (a) congenital lymphedema is divided into two categories: 1. Simple incidence of non-familial or genetic factors. Incidence rate of primary lymphedema of 12%. Physical side of birth are limited or diffuse swelling, not pain, no ulcers, rarely complicated by infection, generally in good shape, was particularly prevalent in the lower extremities. 2. Hereditary, also known as Milroy disease, is rare. There are more than the same family illness, or after birth, the disease affected mostly the side of lower limbs. (B) Early-onset lymphedema mostly female, male to female ratio 1:3, onset age from 9 to 35,70% for the unilateral. Significantly induced in the absence of the general emergence of the next mild swelling of ankle and foot, standing, activities, menstrual period and when the warmer climate increase. Refers to high-limb edema may temporarily alleviate. Lesions gradually increase and spread to the lower leg, but generally no more than the knee. The latter may be typical quot;elephant skin legsquot;, but rarely complicated with ulcer and secondary infection. (C) infection of lymphedema include bacteria, fungi, and other filarial infections. Toe cracks, or blisters on the skin is the most common pathogen invasion channels, followed by lower extremity varicose ulcer complicated by secondary infectionAnd other localized injury or infection is also a way to bacterial invasion. In addition, the female pelvic inflammatory disease caused by inflammation of the pelvic lymph nodes, will enable the return of lower extremity lymphatic lymphatic obstruction caused by non-limb swelling has been reported. Streptococcus is the most common secondary infection of pathogenic bacteria. Clinical to recurrent acute cellulitis and acute lymphangitis is characterized by severe systemic symptoms, and chills, accompanied by high fever and nausea, vomiting, swollen lymph nodes accompanied by local tenderness ditch. Anti-inflammatory and symptomatic treatment after symptoms subside quickly, but slow to ease local lesions, easily repeated. Every time after onset of swelling in the lower limbs to increase, eventually the skin appears rough verrucous by biology, a small number of chronic ulcers secondary to. Itself or secondary infection of tinea pedis caused lymphedema is generally limited to foot and back foot, a serious fungal infection is often acute cellulitis and acute lymphangitis precursor. Control of fungal infection is to prevent lymphedema, one of effective measures. Filarial flu in China#39;s southeast coastal areas of lower extremity common causes of lymphedema. Incidence of 4 to 7 percent, mostly men. Filarial infection in varying degrees of fever and local pain. Filarial infection of lower extremity repeatedly so that the local lymphatic narrow, obstruction, destruction, their skin and subcutaneous tissue distal lymph return blocked, there lymphedema. Localized lesions, such as tinea pedis or secondary recurrent erysipelas-likeTo lymphatic obstruction and infection as both cause and effect, forming a vicious cycle that will eventually become a typical quot;elephantiasis leg.quot; Its flash, scrotal lymphedema number of non-rare, late to the scrotum can be extremely swollen. This is also infected with filarial lymphedema of the characteristics of a major. (D) traumatic lymphedema lymphedema after the main break up and after radiotherapy lymphoedema. 1. Lymphedema after surgery often occurs after lymph node dissection in breast cancer after radical arising from the side of the upper limb lymphedema is particularly common. After extensive lymph node dissection distal lymphatic obstruction, lymph stimulate fibrosis, one by one so that increasing swelling. Lymphedema occurs after timeLarger difference between the general after the beginning of physical activity that is mild proximal limb swelling, but may also occur in a few weeks even after a few months. 2. Lymphoedema after radiotherapy depth of X-ray and radium therapy caused by local tissue fibrosis, lymphatic obstruction caused by lymphedema. (E) of malignant primary and secondary lymphedema of the lymphatic system malignant lymphatic obstruction may produce lymphedema. The former found in Hodgkin#39;s disease, lymphatic sarcoma, Kaposi sarcoma and multiple hemorrhagic sarcoma lymphangioma. Lymphatic sarcoma, although rare, but long-term lymphoedema is the result of malignant transformation occurred in a limb after radical mastectomy for breast cancerLymphedema patients are generally in the 10 years after the disease, the first red or purple skin spots, showing multiple, after integration into ulcerative mass. Limb lymphedema after onset is even more serious. For biopsy should be timely. After a clear diagnosis of the need for amputation. Lesions secondary to breast lymphatic system, cervix, labia, prostate, bladder, testis, skin, skeleton, such as in metastasis of cancer cases. Sometimes small primary tumors, not found by clinical manifestations of chronic onset, painless, progressive lymphedema. Therefore, lymphedema is unknown, should be alert to the possibility of tumor, lymph node biopsy, when necessary, a clear diagnosis. In addition, pregnancy and many other systemic diseases such as pneumonia, influenza, typhoid fever, also can lead to recurrent cellulitis and lymphangitis, while venous thrombosis and lymphatic obstruction caused by lymphedema. 銆?銆怑xamination (a) diagnostic analysis of subcutaneous tissue fluid puncture edema tissue fluid analysis, contribute to the differential diagnosis of difficult cases. Lymphedema fluid protein content is usually high, typically 1.0 ~ 5.5g/dl, and simple閮佹粸vein, heart failure or hypoproteinemia of edema fluid protein content in the 0.1 ~ 0.9g/dl. Check often for chronic swelling of the thick limbBody, just to operate a syringe and fine needle aspiration, a simple and convenient. But we can not understand the lymphatic lesion and functional situation. Is a rough diagnostic methods. (B) lymphatic lymphatic imaging contrast agent injection, X-ray film showed that the morphology of the lymphatic system a method of examination is lymphoedema of the specific examination. 1. 鈶?indications identify lymphedema and venous edema. 鈶?identification of primary lymphedema and secondary lymphedema. 鈶?to line the lymphatic - venous anastomosis were. 2. The current method of lymphatic imaging lymphatic most direct contrast injection method. First dorsal metatarsal 1 ~ 4Subcutaneous injection of Evans blue level of .25 ~ 0.5ml3 ~ 5 minutes we can see small blue strip of superficial lymphatic vessels. Separation of the skin incision under local anesthesia of superficial lymphatics in the proximal and distal to bypass one of the fine thread, temporarily blocked proximal to lymph stranded, with 27 ~ 30, lymphatic puncture needle, and then into 1% Procaine did little to confirm but not leaks in the cavity, fixed needle, and syringe through the plastic pipe to connect to 0.1 ~ 0.2ml / minute speed of the uniform injection Ethiodol12ml (B-lipiodol). 2ml injection in the ankle and pelvic X-ray film to identify whether the contrast agentExtravasation and put into intravenous misuse. Bi Shou pulled injection needles, lymphatic ligation to prevent lymphatic leakage, suture the skin. Contrast radiography include: anterior and posterior leg, posterior thigh from the groin to the before and after the first lumbar vertebra, and oblique or lateral. 3. The abnormal lymphatic imaging performance of primary lymphedema 鈶? absence of lymphatic or valve dysfunction, tortuous lymphangiectasia. 鈶?secondary lymphedema: lymphatic middle lymphangiectasia remote, tortuous, and do not increase in the number of rules. Metastatic lymph nodes within the filling defect can be seen, like moth-eaten edges. 4. 鈶?incision complications of infection, Lin Ma leakage. 鈶?fullBody reaction: fever, nausea, vomiting, because of the contrast agent around the allergic individual may have circulatory collapse. 鈶?local lymphatic inflammatory response to increase lymphedema. 鈶?pulmonary embolism: increasing the pressure of contrast agents may enter through collateral venous anastomosis, caused by pulmonary embolism, the incidence rate was 2 ~ 10%, literature reports of death due to pulmonary embolism. (C) isotopes as a result of lymphatic imaging X-ray imaging lymphatic lymphatic system can not provide quantitative kinetic data, we can not provide the physical location of different simple lymphatic drainage, and therefore a valuable ongoing static within the lymphatic system Shuo imaging (nuclearSu-imaging) to 99m Tc-chain sulfide plastic materials 0.25ml (75MBq) injected into the subcutaneous tissue webbed feet the second toe. R cameras are used on the patients lower abdomen and groin area, respectively, in 1 / 2, 1,2 and 3 hours for a static image scanning, and then calculating the groin lymph nodes, respectively, the isotope uptake capacity. Chronic use of isotope imaging study of the lymphatic function of lymphedema, suggesting that limb reduction in the extent of lymph reflux and the severity of lymphedema related. In more severe lymphedema, isotope uptake rate is almost 0, and in veno-venous reflux of lymph edema increased significantly the percentage of absorption. Therefore can be used to lymphocyticEdema and venous edema of the differential, the diagnosis of lymphedema was 97% sensitivity and specificity of 100%. And lymphatic vessels compared to X-ray angiography, radionuclide imaging is simple, clear diagnosis. But it can not be lymphatic anatomy and lymph node location. If surgery is considered lymphatic lymphatic vessels are still better than X-ray sialography. In addition, the new blood vessels to carry out non-destructive testing technologies can also contribute to venous and lymphatic edema Edema of identification, as an outpatient screening method is simple and both sides will be. 銆愩'?Early differential diagnosis of skin and subcutaneous tissue due to changes in light, with the identification of other diseases: 1. Venous edema oftenIn the lower extremity deep venous thrombosis, sudden unilateral limb swelling of acute onset, associated with skin color bruising, gastrocnemius and femoral triangle marked tenderness, superficial vein to show its clinical features, foot edema was not obvious. Lymphedema is a relatively slow onset to foot more often swollen ankle. 2. Angioneurotic edema allergic edema occurred in the outside factors, the rapid onset, soon faded, for the characteristics of intermittent attacks. Lymphedema showed the trend of gradual increase. 3. Systemic diseases hypoproteinemia, heart failure, kidney disease, liver cirrhosis, such as mucous edema of lower extremity edema can be produced. Bilateral symmetry is generallyAnd accompanied by their respective primary clinical manifestations of disease. After detailed history often asked about the need for careful physical examination and laboratory tests to check your identification. 4. Congenital arteriovenous fistula of congenital fistula may be manifested as static and dynamic limb edema, but the general鑼簂imb length and circumference were greater than contralateral, skin temperature increased, varicose veins, local area and the vascular murmur could be heard, around the vein oxygen concentration close to arterial oxygen content. The above-mentioned are the property of their unique characteristics. 5. Lipoma a small number of lesions a very wide range of fat or fat tissue tumors can be confused with lymphedema. However, most were the limitations of lipoma growth, course of slow, soft, subcutaneousEdema-free performance, if necessary, feasible soft-tissue X-ray mammography to assist in diagnosis
Elephantiasis can cure?
Answer
銆怬verview銆?lymphoedema lymphoedema refers to certain parts of the body back to blocked lymph soft tissue fluid caused by repeated infection in the body after subcutaneous fibrous connective tissue hyperplasia, fat hardening, if the enlargement is physically, the latter of skin thickening, rough, resilience, such as elephantiasis, also known as quot;elephantiasis.quot; 銆?銆?diagnosis. There immitis infection or history of recurrent attacks of erysipelas, or axillary, inguinal lymphadenectomy accepted and the history of radiation therapy. 2. Early limb swelling, reduce post-elevation. Late limb swelling Obviously, the surface rough diagonalization, was rubber-like swelling. A small number have cracked skin, ulcers or verrucous neoplasm. 3.Volvulus-infected persons can be found around the blood test granulosus actin. Lymphatic lymphatic imaging to determine the situation of the development or obstructed. 銆?銆怢ymphedema treatment sooner or later according to the course, the principle of different treatment. Pent-up stranded in the early to rule out lymph, lymphatic fluid to prevent the aim of regeneration, while the late recovery can not be surgically removed lesions or shunt in the treatment of limitations for the purpose of lymphatic obstruction. (A) the acute phase of lymphedema, mainly of non-surgical treatment. 1. Postural drainage down the state under the limb so that organizations stranded gap in lymph increased鎶珮鎮ｈ偄30 ~ 40cm can use gravity to promote the lymph return, byLight edema. This failure is simple and effective, but the role of non-durable, re-limb edema increase sag. 2. Compression bandaging in the basis of postural drainage, in the limb refers to things with high elastic compression stockings or elastic bandages dressing, squeeze space organization to help the lymphatic return. Stretch elastic bandage should be appropriate. Gap pressure can also be used (intermittent compression pumps) and a long time on many occasions to use to improve a certain effect edema. Reported in the literature abroad lymph pressure for the current (lymha-press) a more advanced and efficient compression of the inflatable devices, inflatable devices sub -9 ~ 12, each pneumatic compression alone, compression gradually from distal to proximal limb, and a cycle of 25 less. Shun such lymphatic pressure than other simple pressure of the pneumatic compression device significantly shortened the time (a simple cycle pressure inflatable device about 100 seconds), at the same time can generate higher pressures up to 15.6 ~ 20.8kPa (120 ~ 160mmHg) than surgery and elastic socks simply more effective in swelling. But its use of more complex organizations can not reduce the gap in the protein composition, is only applicable to the acute stage and preoperative preparations, such as short-term treatment. 3. Restricted sodium intakeAnd use of diuretics in acute phase of appropriate restrictions on intake of sodium chloride, generally 1 ~ 2g / d, in order to reduce the organization of sodium and water retention. At the same time, the use of appropriate diuretics, sodium excretion to speed up the water. Hydrochlorothiazide can be used for each urine thiophene 25mg, 3 times a day and, where appropriate, potassium supplement, to be in stable condition after the service stopped. 4. The prevention of infection by selection of anti-fungal ointment, powder, dry toes to maintain the prevention and control of fungal infection in the most effective method; toe a bed is also more common bacterial infections, should be ground cut nail means to remove dirt and reduce bacterial invasion way. When symptoms of systemic streptococcal infection when penicillin and other drugs should be used with bed restActive infection control. Lymphedema complicated by late chapped skin ointment external use skin protection and lubrication. In addition, a variety of vaccines, milk and protein injection of the opposite sex is well-established anti-infective therapy. The body#39;s various defense agencies to be boosted. Foreign scholars to prove the injection of typhoid vaccine, the output of lymphocytes in lymphatic increased blood levels of gamma globulin also increased, and prevent the occurrence of a permanent role of lymphatic obstruction. Authors speculate heterosexual protein may play a role through the pituitary and adrenal glands. (B) chronic lymphedema, including non-surgical treatment of the drying treatment and a variety of stretch surgery. 1. Bake bake tightrope stretched therapy therapy is to explore the heritage of a Chinese medicine treatment. Its treatment of the principle is the use of continuous radiant heat, so that the skin vasodilator limb, a large number of sweating, local tissue clearance of the liquid back into the blood and improve lymph circulation. Has not happened for limb lymphoedema severe skin drying hyperplasia can stretch therapy selection. An electric radiant heat treatment and oven heating methods. Temperature control in the 80 ~ 100 鈩? day 1, each 1 hour, 20 times as a course of treatment. Each treatment interval of 1 ~ 2 weeks. End of each treatment should be applied elastic bandage. The basis of clinical observation by 1 ~ 2 months after treatment shows that limbOrganization of the loose limbs gradually reduce, in particular, Erysipelas-like episodes greatly reduce or stop seizures. 2. Surgical treatment of lymphedema without the majority of surgery. About 15% of primary lymphedema of lower limb surgery ultimately line. In addition to the existing methods of amputation surgery can not cure lymphedema, but significant improvement in symptoms. 鈶?surgical indications: 鈶?limb dysfunction: fatigue as a result of heavy physical activity and joint restrictions. 鈶?excessive swelling with pain. 鈶?recurrent cellulitis and lymphangitis invalid by the medical treatment. 鈶?lymphatic sarcoma: Long-term lymphedema causes fatal malignant. 鈶?beauty: most ofThe number of patients with primary lymphedema for young women, for obvious swelling and the requestor may wish to consider cosmetic surgery, but it should be to improve the function-oriented, beauty Des country, or may be unsatisfactory therapeutic effect. Preoperative preparation and postoperative management: 鈶?preoperative preparation for surgery plays an important role in the effect. They include: 鈶犳姮楂樻偅鑲ed rest: so that limb edema decreased to a minimum. There elevate lower extremities, lower extremities and skeletal traction suspension and so on, up to 60 lower limbFlaps less chances of infection. 鈶?cleansing the skin: to achieve ulcer healing or control of the purpose of local infection. 鈶?to maintain patency after drainage; the separation of rough surface can be sustained capillary oozing. Vacuum must be placed to maintain the flap effusion of blood under the non-plot to reduce the impact of skin flap blood supply factors, to prevent the billet flap death, infection, surgery to reduce the failure rate. 鈶?after鎶珮鎮ｈ偄continue to reduce limb edema, is conducive to venous and lymphatic return. 鈶?surgery Category: lymphedema surgery can be divided into two types: 鈶?extensive resection lesions. 鈶?reconstruction of lymphatic return. According to experimental and clinical evidence, which a good part or most of the effect ofIn fact, removal of lesions in a wide range based on the progress. Simple reconstruction of the lymphatic reflux, surgical operation is fine, but have little effect. Secondary lymphoedema due to lymphatic obstruction point near the remote function of the lymphatic system in good condition, surgical reconstruction should be given back to the regional lymph good effect, on the contrary, the majority of primary lymphedema of the last distal lymphatic dysplasia, not stand up to look forward to the reconstruction of the lymphatic reflux surgery can improve symptoms. 銆?銆怢ymphedema etiology classification of the cause of the large number of both the etiology and clinical types can be broadly divided into primary and adoptive two categories. Primary lymphedema is most lymphangiectasia, valveOr absence of dysfunction, such as due to congenital dysplasia. According to lymphatic imaging, can be divided into type of primary lymphedema are as follows: 鈶?lymphatic hypoplasia, with absence of subcutaneous lymphatic; 鈶?lower lymphatic development, lymph nodes and lymphatic vessels rather than small; 鈶?lymphoid hyperplasia, lymph nodes and lymphatic vessels with large more distorted from time to time and varicose. Which is very rare lymphatic hypoplasia, common in congenital lymphedema. Development than is the most common type. Simple and are鍜恛f congenital lymphedema. Early-onset lymphoedema were more common in adolescent women or young women, increase in symptoms of menstrual period, so that the cause may be related to endocrine-related disorders, or primaryLymphedema of 85 ~ 90%. 35-year-old said after the onset of late-onset lymphedema. The majority of secondary lymphedema caused by lymphatic obstruction. Is the most common of lymphatic filariasis edema and lymphedema of streptococcal infection. Breast cancer of upper limb lymphedema after radical mastectomy is not uncommon. Although Herophilos and Aristotle as early as the third and fourth century of the lymphatic system has been observed, in modern times has done a great deal of experimental research, however, lymphedema of the exact pathogenesis is not clear. Category: (a) 1 of primary lymphedema. Congenital: simple genetic (milroy disease) 2. early-onset (b) 1 secondary lymphedema. infection: parasites, bacteria, fungi, etc. 2. injury: surgery, radiation therapy, burns, etc. 3. malignancies: the primary tumor, secondary tumor 4. other: systemic diseases, pregnancy and other pathological changes銆?銆恖ymphoid cell gap in the tissue fluid, the flow of lymphatic venous return. Lymphatic circulation is also a physiological function of the physical cycle. Congenital dysplasia of the lymphatic system or as a result of occlusion of one reason or another, or damage occurred, that is, back to their remote lymphatic obstacles occur, organizations abnormal lymph increased clearance.If there is physical involvement in the physical uniformity of the thickening, at first the skin is still smooth, soft,鎶珮鎮ｈ偄edema subsided significantly. As a result of the accumulation of lymph is rich in protein, can be as high as 5.8g/dl, 銆斻'?normal long-term stimulus to make 0.72g/dl dysplasia of connective tissue, adipose tissue to replace a large number of fibrous tissue. Extreme thickening of the skin and subcutaneous tissue, skin keratosis, rough, mean pressure does not occur after the indentation, there verruciform by biology, the formation of a typical quot;elephantiasis.quot; Infection so that an increase of inflammatory exudate to stimulate a large number of connective tissue hyperplasia, more lymphatic damage, increase the lymph stranded, an increase of secondary infectionOpportunity to form a vicious cycle, resulting in increasing lymphedema. Clinical manifestations銆?銆恈ause the light of the above categories, will be the clinical features of their own are as follows: (a) congenital lymphedema is divided into two categories: 1. Simple incidence of non-familial or genetic factors. Incidence rate of primary lymphedema of 12%. Physical side of birth are limited or diffuse swelling, not pain, no ulcers, rarely complicated by infection, generally in good shape, was particularly prevalent in the lower extremities. 2. Hereditary, also known as Milroy disease, is rare. There are more than the same family illness, or after birth, the disease affected mostly the side of lower limbs. (B) Early-onset lymphedema mostly female, male to female ratio 1:3, onset age from 9 to 35,70% for the unilateral. Significantly induced in the absence of the general emergence of the next mild swelling of ankle and foot, standing, activities, menstrual period and when the warmer climate increase. Refers to high-limb edema may temporarily alleviate. Lesions gradually increase and spread to the lower leg, but generally no more than the knee. The latter may be typical quot;elephant skin legsquot;, but rarely complicated with ulcer and secondary infection. (C) infection of lymphedema include bacteria, fungi, and other filarial infections. Toe cracks, or blisters on the skin is the most common pathogen invasion channels, followed by lower extremity varicose ulcer complicated by secondary infectionAnd other localized injury or infection is also a way to bacterial invasion. In addition, the female pelvic inflammatory disease caused by inflammation of the pelvic lymph nodes, will enable the return of lower extremity lymphatic lymphatic obstruction caused by non-limb swelling has been reported. Streptococcus is the most common secondary infection of pathogenic bacteria. Clinical to recurrent acute cellulitis and acute lymphangitis is characterized by severe systemic symptoms, and chills, accompanied by high fever and nausea, vomiting, swollen lymph nodes accompanied by local tenderness ditch. Anti-inflammatory and symptomatic treatment after symptoms subside quickly, but slow to ease local lesions, easily repeated. Every time after onset of swelling in the lower limbs to increase, eventually the skin appears rough verrucous by biology, a small number of chronic ulcers secondary to. Itself or secondary infection of tinea pedis caused lymphedema is generally limited to foot and back foot, a serious fungal infection is often acute cellulitis and acute lymphangitis precursor. Control of fungal infection is to prevent lymphedema, one of effective measures. Filarial flu in China#39;s southeast coastal areas of lower extremity common causes of lymphedema. Incidence of 4 to 7 percent, mostly men. Filarial infection in varying degrees of fever and local pain. Filarial infection of lower extremity repeatedly so that the local lymphatic narrow, obstruction, destruction, their skin and subcutaneous tissue distal lymph return blocked, there lymphedema. Localized lesions, such as tinea pedis or secondary recurrent erysipelas-likeTo lymphatic obstruction and infection as both cause and effect, forming a vicious cycle that will eventually become a typical quot;elephantiasis leg.quot; Its flash, scrotal lymphedema number of non-rare, late to the scrotum can be extremely swollen. This is also infected with filarial lymphedema of the characteristics of a major. (D) traumatic lymphedema lymphedema after the main break up and after radiotherapy lymphoedema. 1. Lymphedema after surgery often occurs after lymph node dissection in breast cancer after radical arising from the side of the upper limb lymphedema is particularly common. After extensive lymph node dissection distal lymphatic obstruction, lymph stimulate fibrosis, one by one so that increasing swelling. Lymphedema occurs after timeLarger difference between the general after the beginning of physical activity that is mild proximal limb swelling, but may also occur in a few weeks even after a few months. 2. Lymphoedema after radiotherapy depth of X-ray and radium therapy caused by local tissue fibrosis, lymphatic obstruction caused by lymphedema. (E) of malignant primary and secondary lymphedema of the lymphatic system malignant lymphatic obstruction may produce lymphedema. The former found in Hodgkin#39;s disease, lymphatic sarcoma, Kaposi sarcoma and multiple hemorrhagic sarcoma lymphangioma. Lymphatic sarcoma, although rare, but long-term lymphoedema is the result of malignant transformation occurred in a limb after radical mastectomy for breast cancerLymphedema patients are generally in the 10 years after the disease, the first red or purple skin spots, showing multiple, after integration into ulcerative mass. Limb lymphedema after onset is even more serious. For biopsy should be timely. After a clear diagnosis of the need for amputation. Lesions secondary to breast lymphatic system, cervix, labia, prostate, bladder, testis, skin, skeleton, such as in metastasis of cancer cases. Sometimes small primary tumors, not found by clinical manifestations of chronic onset, painless, progressive lymphedema. Therefore, lymphedema is unknown, should be alert to the possibility of tumor, lymph node biopsy, when necessary, a clear diagnosis. In addition, pregnancy and many other systemic diseases such as pneumonia, influenza, typhoid fever, also can lead to recurrent cellulitis and lymphangitis, while venous thrombosis and lymphatic obstruction caused by lymphedema. 銆?銆怑xamination (a) diagnostic analysis of subcutaneous tissue fluid puncture edema tissue fluid analysis, contribute to the differential diagnosis of difficult cases. Lymphedema fluid protein content is usually high, typically 1.0 ~ 5.5g/dl, and simple閮佹粸vein, heart failure or hypoproteinemia of edema fluid protein content in the 0.1 ~ 0.9g/dl. Check often for chronic swelling of the thick limbBody, just to operate a syringe and fine needle aspiration, a simple and convenient. But we can not understand the lymphatic lesion and functional situation. Is a rough diagnostic methods. (B) lymphatic lymphatic imaging contrast agent injection, X-ray film showed that the morphology of the lymphatic system a method of examination is lymphoedema of the specific examination. 1. 鈶?indications identify lymphedema and venous edema. 鈶?identification of primary lymphedema and secondary lymphedema. 鈶?to line the lymphatic - venous anastomosis were. 2. The current method of lymphatic imaging lymphatic most direct contrast injection method. First dorsal metatarsal 1 ~ 4Subcutaneous injection of Evans blue level of .25 ~ 0.5ml3 ~ 5 minutes we can see small blue strip of superficial lymphatic vessels. Separation of the skin incision under local anesthesia of superficial lymphatics in the proximal and distal to bypass one of the fine thread, temporarily blocked proximal to lymph stranded, with 27 ~ 30, lymphatic puncture needle, and then into 1% Procaine did little to confirm but not leaks in the cavity, fixed needle, and syringe through the plastic pipe to connect to 0.1 ~ 0.2ml / minute speed of the uniform injection Ethiodol12ml (B-lipiodol). 2ml injection in the ankle and pelvic X-ray film to identify whether the contrast agentExtravasation and put into intravenous misuse. Bi Shou pulled injection needles, lymphatic ligation to prevent lymphatic leakage, suture the skin. Contrast radiography include: anterior and posterior leg, posterior thigh from the groin to the before and after the first lumbar vertebra, and oblique or lateral. 3. The abnormal lymphatic imaging performance of primary lymphedema 鈶? absence of lymphatic or valve dysfunction, tortuous lymphangiectasia. 鈶?secondary lymphedema: lymphatic middle lymphangiectasia remote, tortuous, and do not increase in the number of rules. Metastatic lymph nodes within the filling defect can be seen, like moth-eaten edges. 4. 鈶?incision complications of infection, Lin Ma leakage. 鈶?fullBody reaction: fever, nausea, vomiting, because of the contrast agent around the allergic individual may have circulatory collapse. 鈶?local lymphatic inflammatory response to increase lymphedema. 鈶?pulmonary embolism: increasing the pressure of contrast agents may enter through collateral venous anastomosis, caused by pulmonary embolism, the incidence rate was 2 ~ 10%, literature reports of death due to pulmonary embolism. (C) isotopes as a result of lymphatic imaging X-ray imaging lymphatic lymphatic system can not provide quantitative kinetic data, we can not provide the physical location of different simple lymphatic drainage, and therefore a valuable ongoing static within the lymphatic system Shuo imaging (nuclearSu-imaging) to 99m Tc-chain sulfide plastic materials 0.25ml (75MBq) injected into the subcutaneous tissue webbed feet the second toe. R cameras are used on the patients lower abdomen and groin area, respectively, in 1 / 2, 1,2 and 3 hours for a static image scanning, and then calculating the groin lymph nodes, respectively, the isotope uptake capacity. Chronic use of isotope imaging study of the lymphatic function of lymphedema, suggesting that limb reduction in the extent of lymph reflux and the severity of lymphedema related. In more severe lymphedema, isotope uptake rate is almost 0, and in veno-venous reflux of lymph edema increased significantly the percentage of absorption. Therefore can be used to lymphocyticEdema and venous edema of the differential, the diagnosis of lymphedema was 97% sensitivity and specificity of 100%. And lymphatic vessels compared to X-ray angiography, radionuclide imaging is simple, clear diagnosis. But it can not be lymphatic anatomy and lymph node location. If surgery is considered lymphatic lymphatic vessels are still better than X-ray sialography. In addition, the new blood vessels to carry out non-destructive testing technologies can also contribute to venous and lymphatic edema Edema of identification, as an outpatient screening method is simple and both sides will be. 銆愩'?Early differential diagnosis of skin and subcutaneous tissue due to changes in light, with the identification of other diseases: 1. Venous edema oftenIn the lower extremity deep venous thrombosis, sudden unilateral limb swelling of acute onset, associated with skin color bruising, gastrocnemius and femoral triangle marked tenderness, superficial vein to show its clinical features, foot edema was not obvious. Lymphedema is a relatively slow onset to foot more often swollen ankle. 2. Angioneurotic edema allergic edema occurred in the outside factors, the rapid onset, soon faded, for the characteristics of intermittent attacks. Lymphedema showed the trend of gradual increase. 3. Systemic diseases hypoproteinemia, heart failure, kidney disease, liver cirrhosis, such as mucous edema of lower extremity edema can be produced. Bilateral symmetry is generallyAnd accompanied by their respective primary clinical manifestations of disease. After detailed history often asked about the need for careful physical examination and laboratory tests to check your identification. 4. Congenital arteriovenous fistula of congenital fistula may be manifested as static and dynamic limb edema, but the general鑼簂imb length and circumference were greater than contralateral, skin temperature increased, varicose veins, local area and the vascular murmur could be heard, around the vein oxygen concentration close to arterial oxygen content. The above-mentioned are the property of their unique characteristics. 5. Lipoma a small number of lesions a very wide range of fat or fat tissue tumors can be confused with lymphedema. However, most were the limitations of lipoma growth, course of slow, soft, subcutaneousEdema-free performance, if necessary, feasible soft-tissue X-ray mammography to assist in diagnosis