Schwellungsempfinden, klinische Schwellungszeichen und manifestes Lymphödem

Zusammenfassung

Hintergrund: Die Begriffe „Schwellungsempfinden“, „klinisch diagnostizierte Schwel-lung” und „Lymphödem“ sind bislang nur unzureichend charakterisiert.

Methoden: In dieser prospektiven Studie be-trachteten wir die Häufigkeit von Beinschwellungen bei 164 Probanden (31 Kontrollperso -nen, 25 Patienten mit chronisch venöser Insuffizienz, 74 mit inguinaler Sentinel-Lymphonodektomie, 34 mit kompletter inguinaler Lymph-knotendissektion). Die Beinvolumina wurden mit dem „Image 3D“-Verfahren bestimmt.

Ergebnisse: Unerwartet hohe Schwellungsraten wurden mit einem Patientenfragebogen ermittelt, deutlich niedrigere durch die klinische Untersuchung. Bei den operierten Pa-tienten erbrachte die Anwendung eines Grenzwertes von 6,5 % Volumenzunahme im Vergleich zum nicht-operierten Bein eine noch niedrigere „Lymphödemrate“. Bei „Schwellungsempfinden” ohne „klinische Schwellungszeichen“ war volumetrisch immer noch eine Flüssigkeitseinlagerung im betroffenen Bein nachweisbar.

Schlussfolgerung: Schwellungsempfinden, klinisch diagnostizierbare Schwellungen und Lymphödem entsprechen unterschiedlichen Ausprägungen einer Flüssigkeitseinlagerung im Bein.

Summary

Background: So far, the thresholds for the presence of leg oedema are not well standardized. The terms leg swelling and lymphoedema are often used as synonyms.

Methods: In this prospective study, we analyzed various aspects of leg swellings: a) the subjectively perceived swelling, b) the clinically detected swelling and c) exact leg volume differences, measured by the Image 3D method. We included 164 study participants (31 control persons, 25 patients with chronic venous insufficiency (CVI), 74 patients with sentinel lymphonodectomy (SLNE), and 34 patients with complete inguinal lymph node dissection (CLND). Applying Receiver Operating Characteristic analysis, a volumetric threshold for the perceived leg swelling was established.

Results: Of the persons included, 67 (41%) reported subjectively perceived leg swellings. The proportions in control persons, in patients with CVI, with SLNE and with CLND were 23 %, 48 %, 31 % and 74 %, respectively. The percentages of clinically detectable swelling were 3 %, 13 %, 15 % and 50 %, respectively. Applying a threshold of 6.5 % volume gain of the operated leg, the lymphoedema rates after SLNE and CLND were 7 % and 35%, respectively. Among the patients with lymph node dissection, we built three groups. 1) patients without perceived swelling or clinical signs of swelling, 2) patients with perceived swelling but no clinical signs of swelling and 3) patients with perceived swelling as well as clinical signs of swelling. In these groups, the mean volume differences between the operated and the non-operated leg were 71 ml (0.9 %), 150 ml (2.2 %) and 477 ml (5.9 %), respectively (P<0.001). A threshold of 2.4 % volume gain of the operated leg provided the best conformity with the perceived swelling.

Conclusions: The perception of swelling can be caused by small amounts of liquid accumulation in the leg and may be present although clinical signs are still missing. Consequently, the highest swelling rates are recorded if a questionnaire is used. Significantly lower swelling rates are found by clinical examination. The lowest swelling rates are observed, if a volumetric threshold of 6.5 % volume gain is applied.

Schlüsselwörter

Lymphödem - Beinschwellung - Volumetrie - Sentinel - inguinale Lymphknotenexzision

Keywords

Leg swelling - Lymphoedema - Sentinel - Complete node dissection - Groin - Volumetry

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