งานประชุมสมาคมมะเร็งนรีเวช (Gynecological Cancer Meeting)
งานประชุมสมาคมมะเร็งนรีเวช โดย ศ.ดร.นพ. วิชัย เอกทักษิณ
วันที่ 11 สิงหาคม 2557
Innovative Use of Schnogh under Twisting Tourniquet©Technique for Lymphedema Therapy: A New Horizon in Quality Management of Gynecologic Patients with Chronic Limb Swelling
Wichai Ekataksin, M.D., Ph.D.,
Lymphology Institute of Thailand
Society for People with Lymphedema and Poor Lymph Disorder
Background For several decades, millions of Thai patients with gynecologic malignancies suffered from limb swelling of postoperative life and had nowhere to go. The total lack for management of lymphedema is a fundamental national health problem, but received little attention so far. With the advent of Schnogh invented in 2006, its use under Twisting Tourniquet©Technique (TTT) has eased the situation, giving thousands of victims a new hope with markedly improved quality of life. Patients and Methods Two types of invention, a paired Schnogh and a cuffed Schnogh were employed as a major tool in conducting compression therapy upon swollen limbs. More than 3,700 patients consulted Thailand Lymphedema Day Care Center during 2006~2014, of which two thirds were related to breast or cervical cancer. For statistic analysis, we, after inclusion criteria, selected 307 patients with unilateral lymphedema of upper extremity and 340 of lower. All individuals underwent an MRI examination for T2W stir/fs, 5-day course treatment, segmental circumference measurement before and after TTT, and assessment of truncate cone volumetry. Results and Discussion The protocol of 15-min twist and 5-min untwist was conducted at least 10 sessions a day; twisting pressure was adjusted to 60~90 mm Hg in a manner of distoproximal descending gradient. This procedure created a prolonged compression alternated by a decompression interval that resulted in a remarkable reduction of edema volume each day. At day 5, average volume reduction rate was 50.2% (range 16.5 ~ 112.6%) in upper limb group, and 55.6% (17.8 ~ 113.5%) in lower limb group. The therapeutic effect of TTT compared superiorly to any known treatment modality, such as CDP complete decongestive physiotherapy, IPCP intermittent pneumatic compression pump, and LVA lymphaticovenous anastomosis. Conclusions We have demonstrated the distinct effectiveness of Schnogh as a new treatment modality for managing extremity lymphedema secondary to gynecologic cancer. It was tested over the largest number of patients ever reported. Doubtless the invented device combined with the innovative technique appeals strongly to established centers where lymphedema patients are handled by experts and certified therapists. As a matter of fact, ASEAN has only two lymphologists practicing in Thailand to cover 600 million population. We propose accordingly to learned societies of Thai people to take initiative in training professionals to accommodate the coming of AEC 2015.