lymphostasis - a progressive disruption of the normal flow of lymph vessels lymph channel, localized in different parts of the body, and manifests the appearance of persistent swelling of soft tissues with trophic disorders of the skin.As a rule, the initial manifestation lymphostasis develop as a result of lymph vessels of small caliber (peripheral capillaries and lymphatic vessels), and if the pathological processes affecting large lymph collectors and the thoracic duct, develop irreversible changes in the soft tissues.
According to world statistics, the incidence lymphostasis worldwide will reach 250 million people.The incidence of this disease among children is 1: 10,000 and is a congenital lymphedema of the limbs and face in conjunction with dysplastic abnormalities.In the structure of morbidity prevail females aged 30-45 years, accounting lymphostasis lower limbs have at least 90% of cases.
at risk include young persons, and the most common form of the disease is consid
Diagnosis "lymphedema" may establish and treat only qualified phlebologist after a comprehensive examination of the patient in a specialized surgical hospital vascular profile.
prognosis for life in lymphostasis favorable, however, the disease can cause persistent health problems and disability, leading to the patient's disability.
lymphedema of the lower extremities
lymphostasis congenital form of lower limbs due to genetic disorders morphological vascular lymphatic channel, that is, congenital anomalies of the lymphatic vessels (hypoplasia, aplasia and hyperplasia).This severe pathology, the debut of which is the appearance of soft tissue swelling of one limb, most often in adolescence.Congenital lymphedema is a genetically determined disease and can be inherited.
Under developed clinical symptoms of lymphedema is manifested not only local, but also common symptoms significantly impair the quality of life of the patient (vegetative-vascular, hormonal and inflammatory complications).
most effective method of diagnosis lymphostasis lower extremities is MRI, and as therapeutic measures applied lymph drainage massage and physiotherapy (mud packs, ultrasound and thermotherapy).
secondary lymphedema of the lower extremities most often develops after trauma or severe erysipelas.Lymphostasis initial manifestation is edema dorsum of the foot.Patients at this stage do not make any specific complaints, and often in this period does not recognize the disease.
progression of disorders of lymph flow and increases swelling on the skin of the foot appear coarse folds, are not displaced by palpation.At this stage it is necessary to differentiate the existing symptoms of diseases such as neurofibromatosis and gigantism of the lower limb.
In the absence of timely diagnostic and therapeutic measures lymphedema progresses, and pathological changes extend to the proximal lower limb (drumstick and thigh).
There is a classification of the degree of clinical manifestations, which stands 4 severity.For the first degree lymphostasis characteristic lesion of the distal parts of the lower limbs, which manifests itself in the form of deformation and swelling of the foot over the rear surface.At the second degree lymphostasis pathological process is localized on the foot and lower leg.Third degree means defeat not only the foot and lower leg and thigh.At the fourth stage except where noted symptoms appear rough trophic skin changes.
In 70% of cases of upper extremity lymphedema develops after a mastectomy, accompanied by the removal of regional lymph nodes, and in some cases, and the pectoralis minor.Radical removal of regional lymph nodes is done to prevent the recurrence and spread of cancer pathology and without this manipulation can not speak of an effective cure for breast cancer.However, when you delete a group of major lymph nodes and lymph vessels, the conditions for the accumulation of lymphatic fluid in the soft tissues of the shoulder region, and even highlight it through the post-operative wound surface.
In this regard, all the operated patients is recommended to perform special gymnastic exercises designed to improve the flow of lymph.In most cases, lymphedema hands after mastectomy is transitory, and his symptoms disappeared after a month.
In addition, secondary lymphedema occurs after hand burn and infection in the skin, as well as after injuries of different origin.At the stage of the developed clinical picture of upper extremity lymphedema manifests as persistent progressive soft tissue edema and trophic changes in the skin (sores, hyperpigmentation) and irreversible scarring of soft tissues.
existing fixed two groups lymphostasis hands: acute (transient) of not more than 6 months and occurring immediately after a mastectomy, as well as chronic, which lasts for many years and has a persistent progressive course.
the most effective methods of medical treatment are not lymphostasis hands are: manual lymph drainage massage, wearing compression stockings, muscle electrostimulation, magnetic and laser therapy.
In order to prevent the progression of mild lymphostasis and prevent the development of fibredemy, patient after surgery to remove the breast must fulfill a set of gymnastic exercises and self-massage techniques.Of course, having lymphostasis leads to some health problems and disability of women, but in compliance with all the rules of skin care products, as well as performing a doctor's recommendation in terms of physical activity, this state passes its own.
If symptoms appear lymphostasis upper limb after 1 year after surgery and mastectomy accompanied by the formation of seals along the swollen soft tissues, this situation is a cause for a detailed examination of the patient's oncologist for diagnosis of possible recurrence or metastasis of cancer.
main etiopathogenetic link in the development of any localization lymphostasis is the accumulation of lymphatic fluid in the soft tissues and the occurrence of a limited or widespread edema.The average daily rate of formation of lymphatic fluid is about two liters, and its formation is due to the filtration of blood plasma in the interstitial space, and then the lymph enters the lymphatic vessels of the channel.
formation mechanism lymphostasis runs on the same principle, but one in all cases is a violation of the morphological and functional integrity of the vascular lymphatic channel.
There are two main groups of this disease - primary and secondary lymphedema, and laid the foundation of this division origin etiological factor of the disease.
trigger in the development lymphostasis is a disruption of the normal lymph flow through the lymph vessels of small and large caliber.When violating the conditions lymph intralymphatic increased pressure (normally less than 10 mm Hg), to thereby yield the excess liquid, comprising a large percentage of the protein into the surrounding soft tissue.At this stage, the soft tissue does not make any structural changes, edema and is transient.
Later in the tissue decomposes protein and the formation of fibrin and collagen fibers, which manifests itself in the form of a proliferation of connective tissue in the muscle, fascia, subcutaneous fat and skin.These changes are irreversible and progressive.
In connection with the development of scarring in the affected segment is a violation of circulation, which inevitably leads to trophic and inflammatory diseases.
lymphedema can be classified as poly etiology of diseases, since its appearance can be affected by various factors, the main ones are:
- varicose veins of the lower limbs and abdominal vessels, accompanied by chronic venous insufficiency, as a result of which the compensatory vasodilatation lymphaticriverbed, lowering their tone and the development of valvular insufficiency of the vascular wall;
- congenital vascular malformations of the lymphatic system in the form of aplasia (complete absence of a certain segment of the vessels), hypoplasia (underdevelopment of the lymphatic vessels) and hyperplasia (hypertrophy of the vascular wall, excessive tortuosity of the vessel), leading to the development of a primary or congenital lymphostasis;
- mechanical damage to the vascular wall of lymphatic vessels as a result of injury or burn injury;
- compartment syndrome lymphatic vessels around the tumor or inflammatory infiltrate;
- inflammatory changes in the lymphadenitis one segment spread to the lymph vessels are of a different order, with the result that developing valvular insufficiency;
- advanced techniques of surgical interventions in oncology accompanied by radical removal of regional lymph nodes, which inevitably leads to a breakdown in the lymph system;
- specific fillyariozny lymphedema occurs when ingested helminth "filarial 'favorite localization which are vessels lymphatic channel.This type lymphostasis can also be attributed to mechanical lymph channel, since the accumulation of a large number of worms in the lumen of the vessel creates a violation of lymph flow;
- strep systemic failure, which manifests itself in the form of erysipelas is often a trigger in the development lymphostasis localized in the upper or lower limbs;
- diseases of the urinary system at the stage of chronic renal failure lymphostasis provoke the development of the lower limbs and the scrotum.
In the case of signs lymphostasis under the age of 30 years, it is a youthful form of lymphedema, after 30 years, should be suspected late lymphedema.
Favourite localization lymphostasis is defeated upper and lower extremities, but there are other forms of the disease, such as lymphedema of the breast, scrotum, and even the face.
The clinical course lymphostasis allocate basic three stages, the duration of each of them individually for each patient and depends on timely diagnosis, as well as the presence or absence of proper patient management.
So, the first stage lymphostasis only complaint of the patient is stable, progressive and most importantly - reversible swelling of a body part.Unfortunately, many patients do not pay attention to this symptom, and later seek medical help.During this period, the disease does not appear in the patient pain, but only a feeling of "fullness" in the affected area of soft tissue.When pressed on the skin left a trail of small dimples, so this edema is called "soft".Swelling of the affected area is observed in the evening and without medical intervention alone is held before morning, so this form of lymphostasis is called "reversible swelling."The skin is smooth and shiny due to intensive stretching.At this stage simply to achieve positive results from the treatment given the right tools of the conservative therapy.
As the disease progresses to the stage of fibrosis in the patient circuit pathogenetic symptoms that characterize the underlying disease.Specific features lymphostasis in this situation is the emergence of a limited swelling of the soft tissue dense consistency, palpation of the affected area of the skin causing discomfort to the patient, and in some cases even pain.After palpation in soft tissues for a long time, there are traces of the pressure in the form of small dimples.Skin becomes highly sensitive, but no trophic disturbances in this step is not observed.During spontaneous irreversible swelling at lymphostasis often joined by inflammatory changes in the soft tissues, due to the limited violation of lymph and blood circulation.A frequent symptom, appearing at this stage, muscle cramps are caused by a violation of local blood circulation.
During this period, patients focus specifically on changes in the skin, which may indicate a variety of pathological conditions.For example, due to the strong stretching of the skin with massive soft tissue swelling observed dryness and sometimes cracking.The appearance of stains of spilled red, hot to the touch indicates the accession of bacterial infection and the development of a local inflammatory reaction of the skin.The skin is fixed to the deeper subcutaneous fat and fascia dense fibrous strands so it is almost impossible to collect in the fold or depose.
lymphostasis In the last step, which is often referred to as "irreversible elephantiasis" there is a complete violation of the limbs due to a significant increase in its size, connection and installation contractures deforming diseases of bones and joints.The skin becomes brown hue due to induration and fibrosis, and in the absence of adequate therapy on the skin appear warty education and trophic ulcers, accompanied lymphorrhea.Existing statistics of deaths the disease provoked by a generalized septic lesions of the body.
main goals of any treatment at lymphostasis are limiting disease progression, restore metabolic processes and preventing possible complications.The basic principles of treatment are: individual approach and the continuity of a particular method of treatment.
Since the skin at lymphostasis affected to a large extent, all patients recommended to simple rules they care to prevent possible complications of trophic or inflammatory:
- to cleanse the skin should only use funds based on essential oils that do not containpreservatives and perfumes;
- at the slightest damage to the skin should be treated with antiseptic damaged area;
- should be limited to solar and thermal baths (sauna, steam bath, solarium);
- it is not necessary to carry out the injection of drugs into the affected limb;
- preference should be given clothes made from natural fibers, not tight to the skin.
to determine the treatment strategy is necessary to conduct a thorough examination of the patient in order to clarify the causes of the disease.To diagnose lymphostasis apply such instrumental methods of examination, ultrasound examination of the vessels of the lower and upper limbs and organs of the abdominal cavity and small pelvis, lymphoscintigraphy and MRI.
order to achieve positive results in the treatment of lymphostasis should not only use medication and other methods of conservative therapy, but also to normalize the patient's eating behavior.Failure to follow a balanced diet, the conditions for the accumulation of high molecular weight proteins in tissues progressing trophic disturbances in the skin, as well as to reduce the body's immune response, which inevitably leads to infectious complications.