Ätiologie sekundärer Lymphödeme nicht onkologischer Genese^[*]

Zusammenfassung

60% aller Lymphödeme entfallen auf sekundäre Lymphödeme, unter diesen liefern Neoplasien für über die Hälfte die Ursache; ein immer noch beträchtlicher Anteil entfällt damit auf sekundäre Lymphödeme nicht onkologischer Genese. Mit dieser Arbeit wird versucht, einen Überblick über die verschiedenen, in der Literatur erwähnten, Ätiologien dieses Formenkreises zu geben. Prinzipiell kann hier eine Gliederung in zwei Gruppen erfolgen: 1. Ursachen mit immunologischer Aktivität (z. B. Helminthen, Bakterien, Spirochäten, Viren, Pilze, allergische Kontaktdermatitis, Phlebitis, Rheumatoide Arthritis, Morbus Crohn); 2. Ursachen ohne immunologische Aktivität (z. B. Traumata, iatrogene Schäden, Pharmaka, Podokoniose). Hier wird einmal mehr ersichtlich, dass die Erkrankung Lymphödem aufgrund der großen Vielfalt der Ätiologien nicht einer einzelnen klinischen Disziplin untergeordnet werden kann, sondern vielmehr fächerübergreifend gesehen werden muss.

Summary

About 60% of all lymphoedemas are of secondary origin; among those more than a half are caused by neoplasias. Nevertheless, a marked number of secondary lymphoedemas are of non-oncologic origin. The aim of this paper is to present a recent survey of aethiologies for this type of lymphoedema. In general, two groups can be distinguished: 1. causes with immunologic activity (e. g. Filaria, Arthritis), and 2. without immunologic activity (e. g. traumata, surgery). This shows once more, that lymphology cannot be adressed by a single medical discipline, but requires a genuine interdisciplinary approach.

Résumé

Environ 60% de tous les lymphoedèmes sont d’origine secondaire. Plus de la moitié de ceux-ci sont provoqués par des néoplasies. Néanmoins, un nombre important de lymphoedèmes secondaires ne sont pas d’origine cancéreuse. Le but de cet article est de présenter une revue récente de ces autres étiologies. On peut en général observer deux groupes : 1 : à l’origine, avec une activité immunologique (p.ex. filariose, arthrite). 2 : sans activité immunologique (p.ex. traumatisme, chirurgie). Cela démontre une fois de plus que la lymphologie ne peut pas être considérée comme une discipline médicale isolée mais nécessite une approche multidisciplinaire.

Schlüsselwörter

Lymphödem - Ätiologie

Keywords

Lymphoedema - aetiology

Mots clés

Lymphoedème - étiologie

^* Die gegenständliche Arbeit entstand aus dem ersten Teil einer Dissertationsarbeit, die an der Division für klinisch-funktionelle Anatomie, Department für Anatomie, Histologie und Embryologie, der Medizinischen Universität Innsbruck erstellt wurde (95), und setzt die Serie, die mit einem Review zur Ätiologie und Epidemiologie des primären Lmphödems begonnen wurde (74), fort.

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