LYMPHANGIECTASIA (lymphangiectasia; lat. lympha pure water, moisture + grech, angeion a vessel + ektasis expansion) — the permanent sharp expansion of intradermal or intraorganic absorbent vessels connected with functional frustration or morphological reorganization.
Etiology and pathogeny
L. can be inborn or acquired. For inborn L. expansion collector limf, vessels or existence of anomaliyny messages, in particular between limf, vessels of intestines (chyle vessels) and lumbar (lumbar) limf, vessels is characteristic.
The acquired L. develop after injuries, inflammatory processes, as a result to-rykh are damaged ways of a lymph drainage at the level of the main limf, collectors or limf, nodes (are blocked). Thus, at L. conditions for increase limf, pressure, stagnation of a lymph, development of fibroznosklerotichesky changes in fabrics are created up to development elephantiasis (see), emergence lymphorrheas (see) or hilore.
L. can be focal (limited) or widespread (multiple); superficial, deep, trunk.
Superficial L. develop in limf, capillaries and vessels of skin — in papillary and mesh layers of a derma. Deep (visceral) L. proceed from limf, the vessels located in internals: lungs, intestines, spleen etc. Trunk L. are formed at expansion taking away limf, vessels.
At superficial L. in a papillary layer of a derma the cavities filled with a lymph form to-rye put pressure upon epidermis, causing its atrophy, is frequent up to total disappearance. Near the centers of an atrophy of epidermis the hyperkeratosis and an acanthosis are found.
Centers of L., connecting with each other, in papillary and mesh layers of skin form the cavernous cavities reminding lymphangiomas (see). In cavities the endothelial vystilka, a gleam them accurately is defined it is filled with a lymph. Around limf, vessels and L., and also near them large limfoidnokletochny infiltrates are formed.
The clinical picture
the Clinical picture is defined by localization of L. and prevalence of defeat. More often process is localized on the lower extremities, then in generative organs (vulvar lips, a scrotum, a penis), is more rare in internals; also combined localizations meet.
Characteristic wedge, symptoms of L. — increase in volume of the struck body, a segment of an extremity, existence of persistent hypostasis, emergence on skin of the bubbles filled with a lymph. Bubbles have the sizes to 2 — 3 mm, during the pressing are painless and are easily fallen down, and deepening is formed, a cut it is again quickly filled with a lymph.
At a puncture or spontaneous opening of a bubble from it liquid is emitted yellowish and transparent or milky-white color. Quite often in this zone fistula with the long expiration of a lymph forms limf. Depending on localization of process limf, fistulas can be outside and internal, but a wedge, to a current — acute and chronic. The long lymphorrhea (hiloreya) leads to dehydration and exhaustion of an organism, does it susceptible to inf. to diseases. Loss of a lymph through the formed fistulas quite often reaches 1 — 2 l and more in days. At hilory it can be allocated up to 60% of the fat accepted with food and to 5,5% of protein, electrolytes and water are lost.
At a lymphorrhea of the patient constant release of liquid, moistening of skin, linen therefore skin is macerated disturbs, on it there are ulcerations, cracks, inflammatory processes develop.
The diagnosis is made on the basis of the anamnesis, a wedge, by pictures of a disease and data of a limfangiografiya (see. Limfografiya ). Additional diagnostic methods — radio isotope researches krovo-and a lymph flow, biochemical, analyses. Feature of a limfografiya at superficial L. an opportunity to carry out a research by a transdermal puncture expanded limf, a vessel is. Owing to raised limf, pressure a contrast agent is localized preferential in distal departments of the struck area, revealing expanded limf, vessels and the increased their quantity (fig).
Treatment provides bandaging of the affected extremity elastic bandage, observance of the rational mode directed to reduction of developments of stagnation (periodic rest in situation with the raised extremity, the sparing motive mode, etc.).
Operational treatment of L. provides elimination of the reasons, defiant lymphostasis (see). For this purpose in dependence of St of indications make: 1) excision of the hems complicating the Lymph drainage, dissociation patol, sousty; 2) bandaging or embolization of arterial trunks 2 — the 3rd order for the purpose of reduction of a lymphopoiesis; 3) partial or radical excision of the fibrous changed edematous skin, hypodermic cellulose, a fascia together with expanded limf, vessels; 4) creation of new outflow tracts of a lymph by imposing of a direct limfovenozny anastomosis.
At big loss of a lymph hold events for completion of protein, water, electrolytes (see. Lymphorrhea ). Treatment at accumulation of a lymph in serous cavities — see. Pericardis , Peritonitis , Chylous hydrothorax .
The forecast is rather favorable. A determinal factor are terms of the begun treatment and an etiology of a disease.
Bibliography: Anichkov M. N., Zavarina I. K. and Savchenko T. V. Regulation of lymphatic outflow at posttrombotichesky venous insufficiency of the lower extremities, Surgery, No. 9, pages 1 7, 1979; Savchenko T. V. Traumatic damages of absorbent vessels of the lower extremities, Klin, hir., No. 7, page 32, 1978; D on i n i I. and. In a t-t e z z a t i M. The lymphatic system, Padua — L., p. 204, 232, 1972; K i r-s with h n e r H., Eggert A. u. Schroder H. J. Die chirurgische Behandlung des lvmphostatischen Odems, Zbl. Chir., Bd 102, S. 1110, 1977.
M. H. Anichkov, T. B. Savchenko.