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.

목적: 림프부종은 림프계 이상으로 림프액 이동이 원활하지 못하여 생기는 팔다리 조직의 팽창을 의미한다. 현재 가장 효과적인 치료법은 복합적인 림프부종 치료법이지만 이 치료는 수술적 치료가 요구되는 환자에게는 효과가 없다. 이번 연구에서는 물리 치료법에 실패한 환자의 피하 지방조직에 비침습적 바늘 흡인술을 실시하여 그 효과를 알아보고자 하였다. 방법: 2003년 8월 1일부터 2004년 2월 28일까지 일개대학 병원 림프부종 클리닉에 방문하여 상하지 림프부종 2${\sim}$3기를 진단받은 환자를 대상으로 실시하였다. 모든 환자는 1년 이상 복합적인 림프부종 치료법을 실시하였으나 치료에 반응이 없었으며 9명의 환자는 유방암, 12명의 환자는 자궁경부암 환자였다. 치료 전 자기공명영상(MRI)을 실시하여 부종이 가장 심한 부위를 찾아 바늘 흡인술을 실시한 후 3개월 동안 추적 관찰하였다. 치료의 효과는 치료 전과 치료 3개월 후 부종 부피를 계산하여 Wilcoxon signed rank-test를 통해 비교하였다. 결과: 치료 전과 치료 3개월 후의 평균 부종 감소율은 29.1%였다(P=0.001). 국소적 출혈 이외 다른 특별한 부작용은 없었다. 결론: 바늘 흡인술은 복합적인 림프부종 치료법에 반응이 없는 림프부종 2, 3기 환자에게 수술에 앞서 고려해볼 수 있는 안전하고 효과적인 방법이다.

Keywords

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