Non-obstructive lymphoedema of the lower limbs (chyledema). Chyle reflux syndrome: its surgical importance
Linfoedema no obstructivo de los miembros inferiores (quiledema). Síndrome de reflujo del quilo: su importancia quirúrgica
Resumen:
A special type of non obstructive primary lymphoedema of the lower extremities is analysed. In this form, unilateral or bilateral varicose main lymphatic trunks of the lower extremities and abdomen below the cisterne chyli are present. There is also agenesia of the inguinal, iliac, lumbar and aortic ganglions and drainage is performed by non valvuletdcollectors. The important role of the cisterne chyliand the lymphatic ganglions of the system, which prevent backflow of lymph is emphatized. In case the ganglions areabsent and valvless channels are present, backflow syndrome of lymph in the lower extremities develops. Accoding this ethiology and phisiopathologie, the operation proposed by E. Tosatti, consisting in the excision of the suprainguinal coUectors seems logical. The first case of a lymph backflow syndrome in our country is presented. Diagnosis was made by lymphangiography, and Tosatti's operation performed by Dr. J. Mañana. The patient, male, ayed 15 years, developed a 2nd. degree lymphoedema of the right limb when he was 12 years old. The presence of inguinal ganglions on the left side prevented backflow and lymphoedema of the other limb. Post-operative evolution was excellent.
Se analiza un tipo especial· de linfoedema primario no obstructivo de los miembros inferiores, caracterizado por gruesas várices tronculares linfáticas en las region es subcisternales del abdomen y de los miembros inferiores uni o bilateral, asociado a una agenesia ganglionar inguinoiliolumboaórtica y colectores avalvulados. Se resalta el valor fundamental de lacisterna chili y de los ganglios linfáticos escalonados en el sistema, que evitan el reflujo de la linfa en su ascenso antigravitacional. Cuando faltan ls ganglios y existen los colectores, se produce el síndrome del reflujo del quilo hacia los miembros inferiores. De acuerdo a esta etiopatogenia y a los trastornos fisiopatológicos provocados, es lógica la operación propuesta por E. Tosatti de la ligadura suprainguinal de los troncos para evitar el reflujo. Se presenta el primer caso de reflujo del quilo de nuestro país, diagnosticadolinfográficamente y operado de acuerdo a la técnica de Tosatti (Dr. J. Mañana), en un paciente masculino de 15 años de edad, que comenzó con un linfoedema del miembro inferior derecho a los 12 años lución. La existencia de ganglios inguinales izquierdos impidió el reflujo y el linfoedema del otro miembro. La evolución postoperatoria inmediata fue excelente.
2020 | |
várices cirugía sistema linfático miembros inferiores varicose veins surgery lymphatic system low limbs |
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Español | |
Sociedad de Cirugía del Uruguay | |
Revista Cirugía del Uruguay | |
https://revista.scu.org.uy/index.php/cir_urug/article/view/2029 | |
Acceso abierto |
Sumario: | A special type of non obstructive primary lymphoedema of the lower extremities is analysed. In this form, unilateral or bilateral varicose main lymphatic trunks of the lower extremities and abdomen below the cisterne chyli are present. There is also agenesia of the inguinal, iliac, lumbar and aortic ganglions and drainage is performed by non valvuletdcollectors. The important role of the cisterne chyliand the lymphatic ganglions of the system, which prevent backflow of lymph is emphatized. In case the ganglions areabsent and valvless channels are present, backflow syndrome of lymph in the lower extremities develops. Accoding this ethiology and phisiopathologie, the operation proposed by E. Tosatti, consisting in the excision of the suprainguinal coUectors seems logical. The first case of a lymph backflow syndrome in our country is presented. Diagnosis was made by lymphangiography, and Tosatti's operation performed by Dr. J. Mañana. The patient, male, ayed 15 years, developed a 2nd. degree lymphoedema of the right limb when he was 12 years old. The presence of inguinal ganglions on the left side prevented backflow and lymphoedema of the other limb. Post-operative evolution was excellent. |
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