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Abstract
Lower
limb lymphedema is difficult to prevent and diagnose early because its
natural history is unclear. Therefore, the aim of this study was to
clarify its pathogenesis and to identify risk factors that may lead to
early diagnosis. In 29 patients, aged 25 to 74 years with cervical,
uterine, or ovarian cancer
who underwent pelvic lymphadenectomy, indocyanine green fluorescence
lymphangiography was performed with an infrared camera system, and lymph
pumping pressure was measured indirectly preoperatively, and one, two,
three, and six months postoperatively. Of these 29 patients, 22 (75.9%)
completed the examinations. In the non-lymphedema group, the average
lymph pumping pressure did not change significantly at postoperative
follow-up compared with preoperative values. On the other hand, lymph
pumping pressure increased at various time points in five patients who
developed early lymphatic changes with dermal diffusion at the level of
the proximal femur. An increase in lymph flow path resistance due to
pelvic lymphadenectomy resulted in an initial increase in lymph pumping
pressure, followed by a subsequent decrease, in the early lymphatic
changes group. This trend in the pressure change signifies that the
lymph vessels became dysfunctional as they were overwhelmed by the
overload condition and this feature may be a clinically useful signal
for the early diagnosis of developing lymphedema.
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