Obrzęk chłonny jest schorzeniem, z którym coraz częściej spotykają się w swojej praktyce zawodowej zarówno lekarze, jak i fizjoterapeuci. Wynika to z faktu powszechności tej choroby - wg WHO jedna na 20 osób na świecie cierpi z tej przyczyny, oraz z rosnącej liczby czynników etiologicznych, szczególnie chorób nowotworowych mających w powikłaniach obrzęk limfatyczny. Rodzi się zatem potrzeba poznawania mechanizmów powstawania, objawów, a przede wszystkim metod leczenia obrzęków, które umożliwiłyby konkretną i efektywną pomoc chorym. Wyzwania te jako pierwsi podjęli lekarze i fizjoterapeuci niemieccy opracowując kompleksową fizykalną terapię obrzęków. Lata udoskonalania metody pozwoliły na sprecyzowanie skutecznego sposobu leczenia tego schorzenia, zagwarantowały rzeszę wysoko wyspecjalizowanych terapeutów oraz refundowanie tej terapii przez system opieki zdrowotnej.
EN
Lymphoedema is a chronic condition becoming more commonly encountered by both physicians and physiotherapists. It results from the fact that lymphoedema is now more and more widespread - according to the WHO it affects 1 in 20 people in the world. The increasing number of etiological factors, and especially neoplastic disease are also responsible for increasing the prevalence of lymphoedema. Therefore it is very important to study pathophysiology of lymphoedema and to develop more effective methods of treatment. Introduction of modern complex physical therapy of lymphoedema we owe to German physicians who were the first to develop and apply this method to lymphoedema therapy. Over years the CPT method was perfected, great numbers of therapists were trained in CPT and the method was recognized and reimbursed by the German healthcare system.
Upper limb lymphedema (ULL) is the most severe late complication following radical treatment of breast cancer (BC). It can be caused by both cancer recurrence and previous therapy (lymphadenectomy, axillary radiotherapy). In BC survivors, ULL- inducing factors include: previous irradiation treatment, infections within the upper limb or the scar, high BMI. Diagnosis of ULL makes use of measurements of the circumference and volume of the limb, imaging, measuring electrical impedance of tissues and lymphoscintigraphy which determines the type and severity of lymph flow disturbances. ULL has a chronic and progressive nature leading to physical, psychic and social disability and, on rare occasions, to secondary neoplasms of the lymphatic system. Therapeutic management involves: patients’ education, complex physical therapy (manual lymphatic drainage, compression therapy), reduction and drainage surgery (microsurgery) as well as liposuction. The most effective conservative procedures include complex physical therapy and particularly manual lymphatic drainage with compression therapy. Failure of conservative therapy indicates the need for surgery. Liposuction is a currently preferred surgical procedure because of its simplicity and a low percentage of complications. Surgery should be complemented by constant compression therapy. Due to low efficiency of all the methods applied, ULL prevention is of paramount importance. It should consist in rationalising indications for oncological treatment (lymphadenectomy, radiation therapy).
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