Sekonder lenfödemli bir hastada tüp mide cerrahisi öncesi ve sonrası uygulanan kompleks boşaltıcı fizyoterapinin etkinliği: vaka raporu

Yıl 2023, , 158 - 164, 30.08.2023

Hanife Abakay , Hanife Doğan , Ayşe Atilabey Güç , Türkan Akbayrak

https://doi.org/10.15437/jetr.1056814

Öz

Amaç: Bu vaka sunumunun amacı, over kanseri ile ilişkili sekonder lenfödemi olan bir hastada tüp mide cerrahisi (TMC) öncesinde lenfödem şikayeti için uygulanan Kompleks Boşaltıcı Fizyoterapi (KBF) ile aynı hastada TMC sonrasında uygulanan KBF’nin etkisini incelemek ve KBF’nin beden algısı, yaşam kalitesi ve anksiyete seviyesi üzerine olan etkisini araştırmaktı.
Yöntem: Bu vaka raporuna over kanseri ile ilişkili unilateral (sol) alt ekstremitesinde sekonder lenfödem gelişen 44 yaşındaki kadın hasta dahil edildi. Hastaya TMC öncesi ve TMC sonrası 30 seans KBF uygulandı. Tüm değerlendirmeler KBF uygulamasından önce ve sonra yapıldı. Ödem şiddeti çevre ölçümü ve doku altı sıvı yüzdesi (doku altı dielektrik sabiti) ölçümleri ile belirlendi. Hastanın beden algısı, yaşam kalitesi ve anksiyete düzeyi sırasıyla Beden Algısı Ölçeği (BAÖ), Lenfödem Yaşam Kalitesi Anketi (LYMQOL) ve Durumluk-Sürekli Kaygı Envanteri (STAI) kullanılarak değerlendirildi.
Bulgular: Çevre ölçümlerinde en belirgin azalmanın TMC sonrası uygulanan KBF ile quadriceps kasının orta noktasında olduğu bulundu (KBF’den önce 101,1cm→KBF’den sonra 60,8cm). TMC öncesi ve sonrası uygulanan KBF ile sol alt ekstremite doku altı sıvı yüzdelerinde en çok azalmanın sırasıyla malleol (%35,54) ve bacaktaki (%36,84) ölçüm noktalarında olduğu görüldü. TMC sonrası uygulanan KBF ile BAÖ, LYMQOL ve STAI puanları sırasıyla 89, 2,27, 46 puan olarak bulundu.
Sonuç: Bu vaka sunumu TMC öncesi ve sonrası uygulanan KBF’nin lenfödem şiddetini azaltmada ve beden algısını, yaşam kalitesini ve kaygı düzeyini iyileştirmede etkili bir yöntem olduğunu gösterdi. Obez lenfödemli hastalarda TMC öncesi uygulanan KBF’nin cerrahi sonrasındaki tedavinin başarısı üzerine olan etkisini belirlemek için randomize kontrollü çalışmalar planlanmalıdır.

Anahtar Kelimeler

Obezite, Lenfödem, Over kanseri

Destekleyen Kurum

YOK

Proje Numarası

YOK

Efficacy of complex decongestive physiotherapy applied before and after gastric sleeve surgery in a case with secondary lymphedema: a case report

Öz

Objective: This case report aimed to determine the effectiveness of Complex Decongestive Physiotherapy (CDP) applied before and after sleeve gastrectomy (SG) in a case with secondary lymphedema related to ovarian cancer and to investigate the effect of CDP on body image, quality of life, and anxiety level.
Methods: This case report was conducted with a 44-year-old female patient who had ovarian cancer related unilateral lymphedema. Thirty sessions of CDP were applied to the patient before and after SG. All measurements were performed before and after CDP. The severity of edema was evaluated by circumference measurement and percentage of water content (tissue dielectric constant). Body image, quality of life, and anxiety level were evaluated by the Body Image Scale (BIS), Lymphedema Quality of Life Scale (LYMQOL), and the State-Trait Anxiety Inventory (STAI), respectively.
Results: The greatest reduction in circumference measurements between the extremities was observed at the middle point of the quadriceps muscle after SG (before CDP: 101.1cm→ after CDP: 60.8cm). It was observed that the largest decrease in left lower extremity subcutaneous fluid percentages was in the malleolus area (%35.54) and the leg (%36.84) with CDP applied before and after SG. The scores of the BIS, LYMQOL, and STAI following CDP applied after SG were 89, 2.27, and 46 points respectively.
Conclusion: This case report showed that CDP applied before and after TMC is an effective method in reducing the severity of lymphedema and improving the body image, quality of life, and anxiety level. Randomized controlled studies should be planned to determine the effect of CDP applied before TMC on the success of post-surgical treatment in obese patients with lymphedema.

Anahtar Kelimeler

Obesity, Lymphedema, Ovarian neoplasms

Proje Numarası

YOK

Kaynakça

• Fruh SM. Obesity: Risk factors, complications, and strategies for sustainable long-term weight management. J Am Assoc Nurse Pract. 2017;29:3-14.
• Jackson VM, Breen DM, Fortin JP, et al. Latest approaches for the treatment of obesity. Expert Opin. Drug Discov. 2015;10:825-839.
• Chang SH, Stoll CR, Song J, et al. The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012. JAMA surgery. 2014;149:275-287.
• Dore R, Levata L, Lehnert H, et al. Nesfatin-1: functions and physiology of a novel regulatory peptide. J Endocrinol. 2017;232:45-65.
• Sjostrom L, Narbro K, Sjostrom CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357:741-752.
• Kushner RF. Weight loss strategies for treatment of obesity. Progress in cardiovascular diseases. Prog Cardiovasc Dis. 2014;56:465-472.
• Maclellan RA, Couto RA, Sullivan JE, et al. Management of Primary and Secondary Lymphedema: Analysis of 225 Referrals to a Center. Ann Plast Surg. 2014;75:197-200.
• Yosipowitch G, DeVore A, Dawn A. Obesity and the skin: skin physiology and skin manifestations of obesity. J Am Acad Dermatol. 2007;56: 901-916.
• Hidalgo LG. Dermatological complications of obesity. Am J Clin Dermatol. 2002;3:497-506.
• Lu S, Tran TA, Jones DM, et al. Localized lymphedema (elephantiasis): a case series and review of the literature. J Cutan Pathol 2009;36:1-20.
• Bakar Y, Tuğral A. Lower extremity lymphedema management after gynecologic cancer surgery: a review of current management strategies. Ann Vasc Surg. 2017;44: 442-450.
• Berard A, Kurz X, Zuccarelli F, et al. Reliability study of the Leg-O-Meter, an improved tape measure device, in patients with chronic venous insufficiency of the leg. VEINES Group. (Venous Insufficiency Epidemiologic and Economic Study). Angiology. 1998;49:169-173.
• Mayrovitz HN, Weingrad DN, Lopez L. Assessing localized skin-to-fat water in arms of women with breast cancer via tissue dielectric constant measurements in pre- and post-surgery patients. Ann Surg Oncol. 2015;22:1483-1489.
• Hovardaoğlu S. Vücut algısı ölçeği. Psikiyatri, Psikoloji, Psikofarmakoloji (3P) Dergisi. 1992;1(1):11-26.
• Keeley V, Crooks S, Locke J, et al. A quality of life measure for limb lymphoedema (LYMQOL). J Lymphoedema. 2010;5:26- 37.
• Öner N, Le Compte A. Süreksiz durumluk /sürekli kaygı envanteri el kitabı. 1. Baskı. İstanbul: Boğaziçi Üniversitesi Yayını, 1983; 1-26.
• Lasinski BB. Complete decongestive therapy for treatment of lymphedema. Semin Oncol Nurs. 2013;29:20-7.
• Moriondo A, Mukenge S, Negrini D. Transmural pressure in rat initial subpleural lymphatics during spontaneous or mechanical ventilation. Am J Physiol Heart Circ Physiol. 2005;289:263-269.
• Fu MR, Axelrod D, Guth AA, et al. Patterns of obesity and lymph fluid level during the first year of breast cancer treatment: A prospective study. J Pers Med. 2015;5:326-340.
• Chang SH, Stoll CR, Song J, et al. The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012. JAMA surgery. 2014;149:275-287.
• Franco JV, Ruiz PA, Palermo M, et al. A review of studies comparing three laparoscopic procedures in bariatric surgery: sleeve gastrectomy, Roux-en-Y gastric bypass and adjustable gastric banding. Obesity surgery. 2011;21:1458-1468.
• Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet (London, England). 2015;386:964-973.