癌症術後水腫變「大象腿」 微創淋巴管靜脈吻合術改善效果好
2022-07-15 記者莊兆暉／台南報導
南市一名年近6旬的女性因右手腫脹合併疼痛日益加劇，前往奇美醫學中心診治，一般及消化系外科主治醫師陳漢坤替她檢查後發現，竟是右乳癌合併腋下淋巴轉移引發右手臂淋巴水腫，在第1階段乳癌治療後，接著進行淋巴靜脈吻合術，目前淋巴水腫情況已大幅改善，也接受癌症後續階段治療中。
癌症術後水腫不可逆，積極就醫莫遲疑，微創淋巴管靜脈吻合術，重建淋巴液回流替代通路。（奇美醫學中心提供）
陳漢坤指出，癌症手術為了防止癌細胞經由淋巴系統擴散，術中會切除惡性腫瘤附近的淋巴結，包括乳癌、婦科癌症、黑色素瘤、惡性肉瘤、攝護腺癌及頭頸部癌等癌症手術，會因此引起淋巴水腫（Lymphedema）的後遺症，若癌症引發淋巴轉移嚴重影響系統原先功能，部分病人也會出現淋巴水腫問題。
陳漢坤說，淋巴水腫最初症狀不明顯，可能只有無法形容的疼痛、麻木或是腫脹感，最快術後2至3個月即會發作，平均發作時間約為2到5年，若進展到中期時，患側的肢體會更腫，且不容易消腫，一旦進入中後期，患側會比另一邊明顯粗一圈，且關節處變腫和皮膚角質化使得行動不靈活，淋巴水腫處容易造成感染併發蜂窩性組織炎，如果沒有得到妥善的治療，到淋巴水腫晚期患肢嚴重變形，就是俗稱的「大象腿」。
淋巴水腫如果沒有獲得妥善治療，演變到晚期就會導致患肢嚴重變形，就是俗稱的「大象腿」。（奇美醫學中心提供）
目前淋巴水腫的治療，早期以整合式物理治療達到復健效果，若已是淋巴水腫中期，就需要進行手術，目前主要手術方式有淋巴腺自體移植手術、抽脂手術及淋巴管靜脈昒合術等3種。
陳漢坤說，淋巴管靜脈吻合術在國外已相當普及，是利用原本的淋巴管路，將淋巴系統回收水分的路徑導回到心臟的微小靜脈，恢復回收肢體組織液的功能，屬微創手術，可全身或局部麻醉、僅需要數個1至2公分不等的小傷口，術後併發症少，適合在淋巴水腫各時期執行。
陳漢坤說，手術效果越早期介入效果越顯著，可以多階段多次手術，也可以搭配淋巴腺自體移植手術或抽脂手術，加強消腫效果，已有淋巴水腫問題的病人，可以根據自身情形選擇治療方式，但在淋巴水腫手術後，仍須配合物理治療做後續保養，才能保有最佳的生活品質。
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