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Krankheiten OPs Wissenschaft

Therapie und langfristiges Glück beim Lipödem

Nachdem letztes Mal einiges zur Diagnostik des Lipödems erzählt wurde, schreibt Frau Dr. Bauer heute über die Behandlungsmöglichkeiten beim Lipödem.

Therapieansätze

Es wird derzeit unterschieden in eine konservative und eine operative Therapie des Lipödems.  Da eine kausale Therapie derzeit nicht möglich ist, kann mit beiden Ansätzen nur die Problematik verbessert werden, die Ursache jedoch bleibt weiterhin unklar.

  • Das Ziel der konservativen Therapie ist die Entlastung der Extremitäten durch Kompression und Lymphdrainage. Dadurch wird von überschüssige Lymphflüssigkeit entfernt und meistens lässt sich dadurch eine deutliche Schmerzreduzierung erzielen.
  • Die operative Therapie durch Liposuktion (Fettabsaugung) zeigte in Studien eine nachhaltige Verbesserung  mit einer deutlichen Schmerzreduktion und weniger bis gar keinem Bedarf an Kompressionsbekleidung und Lymphdrainagen. Des Weiteren zeigte sich, dass sich nach der Liposuktion der Stoffwechsel der betroffenen Patientinnen und ebenso die Mobilität deutlich erhöhen. Dadurch wird eine weitere Gewichtsabnahme nach der Operation möglich. Dennoch wird das Lipödem als chronische Erkrankung bezeichnet, da ein Leben lang auf eine ausgewogene Ernährung und ausreichend Bewegung geachtet werden muss.

Konservative Therapie

Lymphdrainage

Die manuelle Lymphdrainage ist eine speziell entwickelte Massageart, um die Transportfähigkeit des Lymphgefäßsystems zu verbessern und damit den Abtransport der Flüssigkeitsansammlungen zu ermöglichen. Sie ist besonders wichtig, wenn es sich um eine Kombination aus Lip- und Lymphödem handelt. Es werden kreisende Bewegungen mit sanftem Druck auf die Lymphbahnen durchgeführt. Empfohlen wird die manuelle Lymphdrainage 1-2 Mal pro Woche. Mittlerweile gibt es auch Geräte für zuhause, die mit luftgepolsterten Kammern die Bewegungen des Lymphtherapeuten nachahmen.
 

Der Einsatz sogenannter entwässernder Mittel (Diuretika) ist in aller Regel bei Lipödem-Betroffenen kontraindiziert, also definitiv nicht zu empfehlen, da diese Medikamente nur bei Ödemen bei Herzkrankheiten oder Niereninsuffizienz verwendet werden dürfen und beim Lipödem keinerlei Wirkung zeigen.

Kompressionstherapie

Bei Lipödem Patientinnen ist das konsequente Tragen von Kompressionsstrümpfen entscheidend für den Langzeiterfolg. Dabei unterscheidet man in der Fachwelt sogenannte Rundstrick- von Flachstrick- Kompressionsstrümpfen. Rundstrick eignen sich für Patientinnen mit Venenleiden und die Flachstrick für die Lymph- und Lipödem Patientinnen. Die maßgefertigten Strümpfe müssen individuell ausgemessen und angefertigt werden und der Tragekomfort sollte hoch sein, da die Strümpfe bis zu 12 h am Tag getragen werden sollten. Durch die Kompression von außen kann eine zunehmende Schwellung der Beine im Laufe des Tages verhindert werden.

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Operative Therapie – Lipödem Liposuktion

Ziel der Liposuktion (Absaugung in Tumeszenz Technik) ist die Verringerung des erkrankten Fettgewebes an Beinen und Armen, wodurch das Gewebe erheblich entlastet wird. Die Operationen sind mit ästhetischen Liposuktionen nicht zu vergleichen, da es sich hierbei um Maxi-Liposuktionen handelt, bei denen bis zu 10 Liter Fett pro Sitzung in Vollnarkose abgesaugt werden. Das heißt das Volumen, das abgesaugt wird, ist viel höher als bei ästhetischen Fettabsaugungen. Gleichzeitig kann im Anschluss an die Liposuktion eine Hautstraffung mittels Laser oder Microneedling stattfinden.
Teilweise werden so große Mengen an erkranktem Fett entfernt, dass sogar eine chirurgische Hautstraffung in einer weiteren Operation notwendig wird. Die Vollnarkose und der Volumenverlust sind für den Körper sehr belastend. Nicht selten kommt es zu Kreislaufproblemen und Blutarmut nach der Operation. Der typische Lipödem Schmerz kann allerdings fast vollständig reduziert werden und schon nach der Operation bemerken die Patientinnen eine deutliche Verbesserung des Schmerzcharakters. Für bis zu 6 Wochen müssen Kompressionsbekleidung getragen werden und eine postoperative Lymphdrainage ist empfehlenswert für eine schnelle Regeneration und Heilung des Gewebes.
Eine anschließende konservative Therapie ist entweder gar nicht mehr oder nur noch in reduziertem Umfang notwendig. Die Lebensbehandlungskosten und -zeiten können dadurch entscheidend reduziert werden. Die Bein- und Armform kann in vielen Fällen weitgehend normalisiert werden und es konnte gezeigt werden, dass das abgesaugte Fett an den entsprechenden Stellen nicht wieder zurückkehrt. Obwohl bereits in etlichen Langzeitstudien (Baumgartner et al. 2015, Rapprich et al.2 010, Dadras et al. 2017) die Wirksamkeit der Liposuktion bei Lipödem gezeigt werden konnte,  werden die Kosten der Liposuktion von den Krankenkassen bisher noch nicht übernommen.

 

Sport bei Lipödem

Als geeignete Sportarten haben sich Schwimmen, Aquajogging, Spazierengehen, Langlaufen, Walking oder Nordic Walking bewiesen. Bei allen Wassersportarten hilft der höhere Druck des Wassers gegenüber jenem der Luft, so dass viele Lipödem Patientinnen den Wassersport als wohltuend und sehr hilfreich empfinden. Abgesehen von Wassersportarten sollte jeglicher Sport unbedingt mit Kompressionsbekleidung ausgeführt werden, da es ansonsten sogar zu einer Verschlechterung des Ödems und der Schmerzen in den Beinen kommen kann. Die Flachstrickversorgung ist unter Bewegung besonders effektiv und wirksam, so dass es beim Sport zu einem zusätzlichen Entstauungs- und Massageeffekt kommt. Viele Betroffene berichten auch von Gelenkschmerzen beim Sport. Alle Sportarten mit abrupten Bewegungen (Stop and Go- Sportarten) wie zum Beispiel Tennis oder Kontaktsportarten sollen vermieden und stattdessen Gymnastik und Wassersport betrieben werden.
 
 

Ernährung bei Lipödem

Wusstet ihr, dass der Darm eine große Rolle im Lymphsystem spielt? Zum Beispiel können undichte Lymphgefäße durch Nahrungsmittel, die entzündungshemmend (anti-inflammatorisch) wirken,positiv beeinflusst werden. Da sich beim Lipödem im Körper und im erkrankten Fettgewebe dauerhaft eine inflammatorische Reaktion (Entzündungsreaktion), die durch undichte Lymphgefäße verschlechtert wird, entwickelt, sollte auf eine anti-inflammatorische Diät geachtet werden. Berichten zufolge ist nach einer Liposuktion bei Lipödem eine kohlenhydratreduzierte, anti-inflammatorische Diät am effektivsten um Gewicht zu verlieren und Gewicht zu halten.
Aber was ist eine entzündungshemmende (anti-inflammatorische) Ernährung überhaupt?
Wir alle wissen, dass Entzündungen auf der Hautoberfläche durch lokale Rötung, Hitze, Schwellungen und Schmerzen gekennzeichnet sind. Entzündung ist grundsätzlich keine schlechte Sache, im Gegenteil – es ist der Eckstein der Heilungsreaktion des Körpers. So wäre z.B. eine Wundheilung ohne eine entzündliche Reaktion des Körpers nicht möglich. Also: Entzündung ist Aktion.
Unser Immunsystem initialisiert einen Ablauf von Faktoren, die etwas in unserem Körper verändern können. Wenn die Entzündung über die normale Reaktion hinaus fortbesteht oder keinen Zweck erfüllt, schädigt sie den Körper und verursacht Krankheit. Es ist daher allgemein bekannt, dass Stress, Bewegungsmangel, genetische Veranlagung und die Exposition gegenüber Toxinen zu einer solchen chronischen Entzündung beitragen können. Auch die Wahl der Ernährung spielt eine große Rolle. Es gab mehrere Versuche von Ernährungswissenschaftlern, eine „entzündungshemmende Diät“ zu definieren, die sich darin widerspiegelt, dass es eine sehr saubere und gesunde Art des Essens ist – das „clean eating“.
Studien haben gezeigt, dass die Einschränkung der Kohlenhydratzufuhr bei Personen mit Stoffwechselstörungen die Insulinsensitivität, den Blutdruck, die mikrovaskuläre Funktion und die zellulären Adhäsionsmarker verbessert.
Das oft verpönte Nahrungsmittel Fett ist nicht prinzipiell schlecht. Fett ist wichtig für normales Wachstum und Entwicklung, liefert Energie, schützt unsere Organe, erhält Zellmembranen aufrecht und hilft dem Körper Nährstoffe aufzunehmen und zu verarbeiten.
So ist Fett absolut erforderlich für Reparatur- und Renovierungsarbeiten in jeder Zelle- zu jeder Zeit. Die alten Zellen sterben ab und werden durch neue ersetzt. Dies ist die Grundlage für die Aufrechterhaltung der Struktur und Funktion des gesamten Körpers. Für diese Reparaturarbeiten werden Baumaterialien benötigt, ähnlich wie Häuser gebaut werden. Die meisten der Baumaterialien können durch den Körper selbst hergestellt werden, jedoch manche müssen durch die Nahrung zugeführt werden- die sogenannten essentiellen Nährstoffe, z.B. essentielle Aminosäuren und essentielle Fettsäuren. L-Arginin ist z.B. eine semi-essentielle Aminosäure, die zu gesunden Gefäßen beiträgt und bei Entzündungskrankheiten reduziert ist.  Quellen für L-Arginin sind zum Beispiel Eier, Linsen, Nüsse und nitrit- und nitrathaltige Lebensmittel, Blattgemüse. Essenzielle Fettsäuren stecken vor allem in Lachs, hochwertigen Ölen, Avocados und Nüssen.
Um eine anti-inflammatorische Diät zu verfolgen, sollte auf verarbeitete Fertig-Nahrungsmittel, künstlichen Zucker und frittierte Speisen komplett verzichtet werden. Eine Kohlenhydrat-arme, Protein und Fett-reiche Nahrung ist hierbei angebracht. Genau geschaut werden sollte auf die Zusammensetzung mit einem hohen Anteil an essentiellen Aminosäuren und essentiellen Fettsäuren.

Lipödem Diet

Wer mehr zur Ernährung nach Lipödem Operationen wissen möchte, kann sich auch auf www.lipoheal.de unter „Ernährung bei Lipödem“ schlau machen.
Dieser Artikel ist ein Gastarztbeitrag von Dr. med. Bauer. Wie bei all unseren Gastarztbeiträgen übernehmen wir für die Inhalte kein Gewähr. 

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