According to a number of authors, the incidence of lymphorrhea after surgical treatment of breast cancer reaches 100%. In recent years, new methods of treating postoperative lymphorrhea have begun to appear, including the use of photodynamic therapy (PDT).Purpose of the study: to determine the possibility of using photodynamic therapy in the treatment of postoperative lymphorrhea and to evaluate its impact on the quality of life of patients.Material and methods. A prospective study involving 40 people was conducted. In 20 patients, photodynamic therapy was used in the treatment of postoperative lymphorrhea (main group), in 20 patients, punctures and pressure bandages were used (comparison group). Quality of life was assessed based on the data of the SF-36 questionnaire before the start of treatment, after 3 and 6 months. After 1 year, the condition of all patients was also assessed to identify signs of lymphostasis.Results. In the main group, in patients who underwent photodynamic therapy, lymphorrhea was completely stopped by the end of the third week. In patients from the comparison group at the same time, the volume of daily lymphorrhea was (41.4 ± 0.3) ml. A statistically significant difference was found between the indicators of the physical component of health in patients of the two groups 3 months after the start of treatment: role functioning associated with the physical component, pain intensity, general health and vitality. At the same time, the use of photodynamic therapy did not increase the risk of developing lymphostasis of the upper limb.Conclusion. The study showed that the use of photodynamic therapy in the treatment of postoperative lymphorrhea can reduce the amount of lymph loss, reduce the time of outpatient treatment, and also improve the quality of life of patients, while not increasing the risk of developing lymphostasis of the upper limb.
Purpose: to evaluate the influence of postoperative lymphatic leakage volume and duration on homokinesis and incidence of postoperative complications in oncosurgury patients underwent different operative interventions.Material and methods. The results of treatment of 310 patients subjected to standard elective surgical intervention for a malignant pathology of different organs with regional lymph node dissection were evaluated. The selection criterion was prolonged (more than 7 days) and prominent (over 50 ml a day) lymphatic leakage during the postoperative period. The fluid discharged during the postoperative period was identified as a lymph by cytology. The diagnosis of a malignant pathology was verified in all patients after histological examination and patients were distributed according to established diagnosis.Results. The duration of lymphatic leakage including the outpatient treatment stage varied from 9 days to 1 year and 2 months depending on the type of surgery. The longest lymphatic leakage occurred in 2 patients after radical mastectomy. During the 1st week of observation in patients with daily lymph losses up to 100 ml, no changes in the blood composition were noted. Prolonged lymphatic leakage (1–2 weeks after operation) in a volume over 100 ml a day resulted in reduced protein content in blood plasma, severe lymphocytopenia, increased platelet count. During the postoperative period, complications were detected in 31 patients; at that, during the 1st week of observation, 27 patients experienced initial lymphatic leakage over 100 ml a day. Analysis of fatal outcomes (7 patients) showed that in all patients the lymphatic leakage exceeded 150 ml a day and lasted 1 to 2 weeks. The longest inpatient time was typical for patients after Wertheim's hysterectomy and cystectomy, whereas the longest outpatient treatment was experienced by patients after radical mastectomy and inguinofemoral lymph node dissection.Conclusion. In case of lymphatic leakage over 100 ml a day in oncosurgury patients, it was necessary to make up protein losses and after 7 days of persistent lymphatic leakage it became necessary to consider use of active surgical tactics aimed at liquidation of lymph losses.
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