Effect of a Needle Aspiration in Patients with Lymphedema

암 수술 후 발생한 림프부종 환자의 바늘 흡인술 효과

  • Yang, Gu-Hwan (Departments of Family Medicine, Myongji Hospital, Kwandong University College of Medicine) ;
  • Kwak, Sung-Wook (Departments of Family Medicine, Myongji Hospital, Kwandong University College of Medicine) ;
  • Kim, Sun-Hyn (Departments of Family Medicine, Myongji Hospital, Kwandong University College of Medicine) ;
  • Shin, Young-Tae (Departments of Family Medicine, Myongji Hospital, Kwandong University College of Medicine) ;
  • Hwang, Hee-Jin (Departments of Family Medicine, Myongji Hospital, Kwandong University College of Medicine) ;
  • Park, No-Hyeok (Departments of Radiology Medicine, Myongji Hospital, Kwandong University College of Medicine) ;
  • Yeom, Chang-Hwan (Department of Palliative Medicine, Kangnam St. Mary's Hospital, The Catholic University of Korea College of Medicine)
  • 양규환 (관동대학교 의과대학 명지병원 가정의학교실) ;
  • 곽성욱 (관동대학교 의과대학 명지병원 가정의학교실) ;
  • 김선현 (관동대학교 의과대학 명지병원 가정의학교실) ;
  • 신영태 (관동대학교 의과대학 명지병원 가정의학교실) ;
  • 황희진 (관동대학교 의과대학 명지병원 가정의학교실) ;
  • 박노혁 (관동대학교 의과대학 명지병원 영상의학교실) ;
  • 염창환 (가톨릭대학교 의과대학 강남성모병원 완화의학교실)
  • Published : 2009.03.01

Abstract

Purpose: Lymphedemas are tissue fluid swellings, usually on the arms or legs, and occur as a result of impaired lymphatic drainage. Presently, the most effective treatment available is complete decongestive physiotherapy (CDP). However, this therapy is ineffective in some patients and surgery may be indicated. Herein, we examined the efficacy of minimally invasive needle aspiration of the most enlarged areas in hypodermic adipose tissues, of patients who had failed CDP. Methods: We included 21 patients who were diagnosed with lymphedema stage II-III in the upper or lower extremities and visited the lymphedema clinic at a university hospital from September 1, 2003 to February 28, 2004. All patients had been treated with CDP at least once, but had failed to respond to the therapy for more than one year. Nine patients had breast cancer and 12 had cervical cancer. We identified the area with the most severe edema by using MRI and performed a 16-gauge angio-needle aspiration on the area. The patients were followed up for 3 months. Effectiveness of the treatment was evaluated by comparing the volume of edema before and after the treatment using Wilcoxon signed rank-test. Results: The mean reduction ratio of the volume of edema comparison normal volume was 41.1${\pm}$35.3% (P=0.001). There were no major or minor operative complications except localized hemorrhage. Conclusion: We conclude that a needle aspiration prior to other surgical treatments is relatively safe and effective for those patients who are unresponsive to CDP.

References

  1. Mortimer PS, Regnard CF. Lymphostatic disorders. Br Med J 1986;293(6543):347-8. https://doi.org/10.1136/bmj.293.6543.347
  2. Smith JK. Options & decisions. Oncology nursing in lymphedema management. Innovations in Breast Cancer Care 1998;3(4):82-7.
  3. Mortimer PS. The pathophysiology of lymphedema. Cancer 1998;83(12):2798-802. https://doi.org/10.1002/(SICI)1097-0142(19981215)83:12B+<2798::AID-CNCR28>3.0.CO;2-E
  4. de Godoy JM, Torres CA, Godoy MF. Self-drainage lymphatic technique. Angiology 2001;52(8):573-4. https://doi.org/10.1177/000331970105200812
  5. Azurdia RM, Guerin DM, Verbov JL. Chronic lymphedema and angiosarcoma. Clin Exp Dermatol 1999;24(4):270-2. https://doi.org/10.1046/j.1365-2230.1999.00476.x
  6. Aygit AC, Yildirim AM, Dervisoglu S. Lymphangiosarcoma in chronic lymphedema.: Stewart-Treves syndrome. J Hand Surg 1999;24:(1):135-7. https://doi.org/10.1054/jhsb.1998.0049
  7. Kissin MW, Querci della Rovere G, Easton D, Westbury G. Risk of lymphedema following the treatment of breast cancer. Br J Surg 1986;73(7):580-4. https://doi.org/10.1002/bjs.1800730723
  8. Meek AG. Breast radiotherapy and lymphedema. Cancer 1998;83 (12 Suppl American):2788-97. https://doi.org/10.1002/(SICI)1097-0142(19981215)83:12B+<2788::AID-CNCR27>3.0.CO;2-I
  9. Slavin SA, Upton J, Kaplan WD, Van den Abbeele AD. An investigation of lymphatic function following free-tissue transfer. Plast Reconstr Surg 1997;99(3):730-43. https://doi.org/10.1097/00006534-199703000-00020
  10. Foldi M. Treatment of lymphedema. Lymphology 1994;27(3):1-5.
  11. World Health Organization. Lymphatic filariasis: the disease and its control. Geneva:The Organization;1992.
  12. Sitzia J. Volume measurement in lymphedema treatment: examination of a formulae. Eur J Cancer Care 1995;4(1):11-6. https://doi.org/10.1111/j.1365-2354.1995.tb00047.x
  13. Sistrunk WE. Contribution to plastic surgery. Ann Surg 1927; 85(2):185-93. https://doi.org/10.1097/00000658-192702000-00003
  14. Campisi C, Boccardo F, Alitta P, Tacchella M. Derivate lymphatic microsurgery: indications, techniques, and results. Microsurgery 1995;16(7):463-8. https://doi.org/10.1002/micr.1920160706
  15. Campisi, C, Boccardo F, Tacchella M. Reconstructive microsurgery of lymph vessels: the personal method of lymphatic-venouslymphatic (LVL) interpositioned grafted shunt. Microsurgery 1995;16(3):161-6. https://doi.org/10.1002/micr.1920160309
  16. Baumeister RG, Siuda S. Treatment of lymphedemas by microsurgical lymphatic grafting: What is proved? Plast Reconstr Surg 1990;85(1):64-74. https://doi.org/10.1097/00006534-199001000-00012
  17. Poth EJ, Barnes SR, Ross GT. A new operative treatment for elephantiasis. Surg Gynecol Obstet 1947;84:642-4.
  18. Brorson H, Svensson H. Complete reduction of lymphoedema of the arm by liposuction after breast cancer. Scand J Plast Reconstr Hand Surg 1997;31(2):137-43. https://doi.org/10.3109/02844319709085480
  19. Brorson H, Svensson H. Skin blood flow of the lymphedematous arm before and after liposuction. Lymphology 1997;30:165-72.
  20. 염창환, 정규철. 임파부종 환자에서 부분 감압술을 통해 효과를 본 사례. 한국호스피스완화의료학회 2003;6(2):177-9.
  21. International Society of Lymphology Executive Committee. The Diagnosis and Treatment of Peripheral Lymphedema. Lymphology 1995;28(3):113-7.
  22. Kuhnke E. Die Volumenbestimmung entrundeter Extremitaten aus Umfangsmessungen. Lymphologie 1978;2:35-44.
  23. Sitzia J. Volume measurement in lymphedema treatment: examination of a formulae. Eur J Cancer Care 1995;4(11):11-6. https://doi.org/10.1111/j.1365-2354.1995.tb00047.x
  24. Hutzschenreuter PO, Wittlinger H, Wittlinger G, Kurz I. lymphedema: treated by manual lymph drainage and compression bandage therapy. Arch Phys Med Rehabil 1991;1:166-70.
  25. Ko DS, Lerner R. Effective treatment of lymphedema of the extremities. Arch Surg 1998;133(4):452-8. https://doi.org/10.1001/archsurg.133.4.452
  26. Larson OA, Lassen NA, Quaade F. Blood flow through human adipose tissue determined with radioactive xenon. Acta Physiol Scand 1966;66(3):337-45. https://doi.org/10.1111/j.1748-1716.1966.tb03208.x