| 제목 |
Predicting the Effect of Stellate Ganglion Block on Lymphedema Using Cold Immersion Test |
| 소속 |
Keimyung University Dongsan Medical Center, Department of Rehabilitation Medicine1 |
| 저자 |
Hyo Joon Jin1*, Soyoung Lee1†, Du Hwan Kim1, Yong Min Choi1, Seung Wook No1 |
Introduction
Cervical cancer related lymphedema is caused by damaged lymphovascular system. Also autonomic system regulate lymphatic transfer by regulating lymphatic vessel which collects and discharges waste debris and fluid from the superficial lymphatic system into the systemic circulation. But for now, there is no screening tool for autonomic dysfunction of cervical cancer related lymphedema.
Cold immersion test (CIT) is economic, non invasive and simple test for checking autonomic disturbance. We hypothesized that we could use CIT as a screening test for evaluating autonomic function of cervical cancer related lymphedema and if the patient has abnormal autonomic system, sympathetic ganglion block (SGB) would be effective.
Case
A 61 years old woman, with cervical cancer related lymphedema for 6 years, was referred to our out-patients clinic. She was diagnosed with cervical cancer 15 years ago and did total abdominal hysterectomy with bilateral salpingo-oophorectomy and radiotherapy. We managed her with complex decongestive physical therapy including compression bandage and stocking for 6 years. But her symptom has fluctuated and the compliance with treatment was not good.
We were planning to do SGB and tested her autonomic function with CIT. The result of the CIT was abnormal on both lower extremities (Figure 1). We did Lt. lumbar SGB 2 times every two weeks.
Her subjective and objective symptom was much improved after lumbar SGB and made a very good progress (Table 1).
Conclusion
According to this preliminary report, we can assume that lumbar SGB will improve not only swelling but also heaviness in cervical cancer related lymphedema patients who have abnormal CIT. And there should be continuous research for the effect of SGB in the lymphedema patient with abnormal autonomic regulatory system in the future. |
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Abnormal cold immersion test of both lower extremity
Lymphscintigraphy before lumbar sympathetic ganglion block
Change of the left leg girth and heaviness
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