Causes, Onset, Progression, and Symptoms ②
Main Points About the Onset of Lymphedema
ここでリンパ浮腫の発症について、大きなポイントが二つあります。
The time of onset is different for each individual.
Lymphedema may occur immediately after surgery, but it may also occur after 10 or 20 years have passed, and the timing of onset varies greatly from person to person.
Lymphedema is often already present even when the upper and lower limbs are not thickened.
The symptoms of lymphedema are said to vary greatly from person to person, and if there is a difference in thickness between the upper and lower limbs, the condition may have progressed to a certain extent. Therefore, it is important to understand how lymphedema progresses.
Progression and Degeneration of Lymphedema
When a lymph node is dissected, the lymphatic flow becomes blocked and stagnant in the area. This causes the lymphatic vessels to dilate by first increasing their internal pressure. If this status continues, the lymphatic vessels themselves will then become overwhelmed and undergo degeneration.
We will talk about degeneration in a bit more detail. The two keywords are (1) smooth muscle and (2) endothelial cells.
First of all, the outside of a large lymphatic vessel is composed of a muscle called smooth muscle. Normally, these muscles enable peristalsis of the lymphatic vessels and active transport of lymph fluid against gravity. However, if the internal pressure of the lymphatic vessels continues to rise, the smooth muscle transform, proliferate and thicken, causing the lumen to become narrower and narrower.
Secondly, the inside of the lymphatic vessels is composed of lymphatic endothelial cells that are attached to each other, but due to increased internal pressure of the lymphatic vessels, these adhesions loosen and the individual lymphatic endothelial cells become separated. During this process, lymph fluid leaks out of the lymphatic vessels, reducing the lymphatic vessels’ ability to collect lymph fluid and worsening edema.
Thus, lymphedema progresses as the lymphatic vessels degenerate. In other words, unless the underlying cause of lymphatic obstruction or stagnation is corrected, the degeneration of the lymphatic vessels will steadily progress. Furthermore, lymphatic effusion in various parts of the four limbs has been shown to cause fat deposits and enlargement of adipose tissue. Even if the lymphatic flow in the affected limb was improved via conservative therapy or surgical treatment, the enlarged fatty tissue will remain. This is why early diagnosis and intervention are important for lymphedema.
林明辰Akitatsu Hayashi
龟田总合医院/龟田京桥诊所
淋巴水肿中心 院长
世界上首次宣布使用超音波与干涉断层扫描（OCT）的尖端淋巴管形成技术。我们专注于使用此技术传播更有效的淋巴水肿手术。
