摘要目的:探讨手法淋巴引流综合消肿治疗(CDT)象皮肿的效果，重点关注皮肤质地变化。方法:回顾性分析2016年1月至2018年12月在上海交通大学医学院附属第九人民医院整复外科就诊的下肢象皮肿患者临床资料。对不同病因的象皮肿患者，进行1个疗程(4周)的CDT，测量治疗前后皮肤质地(皮肤水分含量、经皮水分蒸发速率、皮肤纤维化程度)、肢体周径、节段水分，均以患肢与健肢的差值代表患肢各检测指标的水平，采用配对 t检验进行比较，用Pearson相关性检验分析治疗前后节段水分与皮肤质地各参数之间的相关性。治疗期间记录患者主观感觉，采用自制微信问卷随访患者肢体周径自我控制情况，患者生活质量(生活、工作、社交、情绪)改变，绷带及弹力袜的适应性，进行优、良、中、差分级评价。 结果:共纳入20例患者，女16例，男4例；年龄9~70岁，平均50.45岁；5例为原发性，15例为继发性淋巴水肿；病程最长为27年，最短2年，平均8.4年。经1个疗程治疗后，皮肤质地明显改善：皮肤水分含量从治疗前55.6%±7.4%下降至治疗后42.1%±7.4%，差异有统计学意义( P<0.01)，经皮水分蒸发速率从治疗前(14.981±5.699) g·m －2·h －1下降至治疗后(9.312±2.590) g·m －2·h －1，差异有统计学意义( P<0.01)，皮肤纤维化程度从治疗前(0.087±0.042) N下降至治疗后(0.065±0.033) N，差异有统计学意义( P<0.01)；肢体周径从治疗前的(11.09±3.14)cm下降到治疗后的(4.82±2.83) cm，差异有统计学意义( P<0.01)，节段水分从治疗前(4.00±2.14)L下降到治疗后的(1.21±0.78)L，差异有统计学意义( P<0.01)。节段水分与皮肤水分含量、经皮水分蒸发速率、皮肤纤维化程度均有正相关性( r＝0.447、0.429、0.751，均 P<0.01 )。治疗后随访6个月，患者主观感觉良好；患者肢体周径自我控制优13例，良5例，中2例；患者生活质量改变优16例，良3例，中1例；绷带及弹力袜的适应性优9例，良8例，中2例，差1例。 结论:CDT疗法能减少象皮肿皮下水分，有效减小肢体体积，减轻皮肤纤维化程度，提高皮肤屏障功能，改善皮肤质地，恢复肢体外观，提高患者生活质量。

abstractsObjective:To investigate the effect of complex decongestive therapy(CDT) on elephantiasis and skin texture improvement.Methods:The clinical data of patients with elephantiasis of lower limbs who were admitted to the Department of Plastic Surgery, Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2016 to December 2018 were retrospectively analyzed. The patients with elephantiasis of different causes were treated with CDT for 1 course (4 weeks). The skin texture parameters (skin water content, transepidermal water loss, skin fibrosis), limb circumference and segmental edema were measured before and after treatment and analyzed by paired t test. Pearson correlation analysis was used to detect the correlation between segmental edema and skin texture parameters before and after treatment. The subjective feelings of patients were recorded during follow-up. A self-designed online questionnaire was used to follow up the patient’s disease control status, including the limb circumferences, changes in quality of life (life, work, social and emotion), the adaptability to bandages and elastic socks. Data were classified and analysed as excellent, good, medium and poor.Results:A total of 20 patients were included, including 16 females and 4 males. The average age was 50.45 years (ranged 9-70 years). 5 cases were primary lymphedema and 15 cases were secondary lymphedema. The duration of the disease ranged from 2 years to 27 years, with an average of 8.4 years. After 1 course of treatment, the skin texture was significantly improved. The skin water content decreased from 55.6%±7.4% before treatment to 42.1%±7.4% after treatment ( P< 0.001). The transepidermal water loss decreased from (14.981±5.699) g·m -2·h -1 before treatment to (9.312±2.590) g·m -2·h -1 after treatment. The skin fibrosis decreased from (0.087±0.042) N before treatment to (0.065±0.033) N after treatment ( P<0.001). The circumference of the affected limb decreased from (11.09±3.14) cm before treatment to (4.82±2.83)cm after treatment ( P<0.001). The segmental edema decreased from (4.00±2.14)L before treatment to (1.21±0.78) L after treatment. Segmental edema was positively correlated with skin water content, transepidermal water loss, and skin fibrosis ( r=0.447, r=0.429, r=0.751, P<0.05). The patients were followed up for 6 months after treatment. The circumference control was excellent in 13 cases, good in 5 cases and moderate in 2 cases. The quality-of-life changes were excellent in 16 cases, good in 3 cases, medium in 1 case. The adaptability of elastic material was excellent in 9 cases, good in 8 cases, medium in 2 cases and poor in 1 case. Conclusions:CDT can reduce subcutaneous edema, effectively reduce limb volume, decrease skin fibrosis, improve skin barrier function, improve skin texture, restore the appearance of the limb and improve patients’ quality of life.