Stage II breast cancer related lymphedema of the right upper extremity

Lymphedema represents a generalized buildup of extracellular lymph fluid within the soft tissues of arms and legs. This results from an imbalance in the amount of lymphatic fluid that is being produced and the amount of lymphatic fluid that is being cleared from lymphatic channels into the venous circulatory system.

淋巴水肿归类为原发性淋巴水肿或继发性淋巴水肿。原发性淋巴水肿是一种相对罕见的疾病，是由于淋巴通道的结构和/或功能继发的淋巴引流系统中的内在结构或功能问题所致。

继发性淋巴水肿更为普遍，是淋巴运输外部破坏的结果。在更发达的西方世界中，这是正常淋巴途径的外科手术破坏最常引起的。癌症治疗，尤其是手术和放射疗法会导致淋巴水肿的发展。乳腺癌手术是手臂中继发性淋巴水肿的最常见原因。作为其治疗的一部分，去除或辐照腋窝淋巴结的应收因素特别高的风险患这种疾病，这可能会在手术后几年出现。腿部的淋巴水肿最常与妇科癌，泌尿科癌，黑色素瘤和淋巴瘤有关。

Lymphedema has a major impact on the quality of life of affected patients, both in terms of increased morbidity and significant psychological effects. The skin and soft tissues of the affected limb become progressively swollen, firm, and tight feeling due to the buildup of entrapped lymphatic fluids. The swelling can feel uncomfortable or even painful, and may make movements more difficult. Most seriously, this condition makes the affected limb much more prone to repeated and potentially life-threatening skin and soft tissue infections. Many patients eventually develop depression as a consequence of the impact that lymphedema has on their well-being and their physical appearance.

目前，无法治愈淋巴水肿，这会影响患者余生。但是，存在非手术和手术管理策略，试图减少受影响肢体内细胞外淋巴液的积累，从而改善症状并降低并发症的风险。

The main non-surgical management strategy, Complex Decongestive Therapy (CDT), includes manual lymphatic drainage, compression therapy, exercise and skin care as well as a range of motion, breathing and posture exercises, and education.

手术管理策略包括消融手术方法，旨在去除受淋巴水肿影响的组织以及生理手术方法，旨在重新创建正常或替代途径以使淋巴液流出受影响的肢体。

消融手术方法可能具有显着侵入性，并针对去除受影响肢体的水肿表面组织层。这包括Charles程序和吸力辅助脂肪切除术/吸脂术。查尔斯的手术代表了一种有些自由基的手术程序，其中从受影响的肢体中切除不同程度的皮肤和皮下组织，并且可能需要对皮肤移植物进行覆盖。吸力辅助脂肪切除术/吸脂术代表了一种侵入性的手术程序，使用多个小切口在皮肤下传递的插管和吸脂装置，从受影响的肢体中除去多余的脂肪。

Physiological surgical methods are directed towards reducing the lymphatic fluid burden in the affected limb by either improving lymphatic circulation by introducing healthy tissue into the affected limb or creating an alternate outflow pathway for lymph fluid. These methods require using sophisticated microsurgical and super-microsurgical techniques, to accomplish the physical reconnection of lymphatic channels to either small veins in the affected limb, or healthy lymphatic channels or tissues that can be harvested from other parts of the body.

While currently available surgical management strategies can result in dramatic improvement in symptoms and quality of life for patients, many formidable challenges remain for successful management of secondary lymphedema. It is hopeful that ongoing clinical research efforts will ultimately lead to more complete and sustainable treatment strategies and perhaps a cure for secondary lymphedema, its debilitating symptoms, and its potentially devastating resultant complications.