Brorson H
Das Lymphödemteam, Abteilung für Plastische und Rekonstruktive Chirurgie, Malmö Universitätsklinikum, Malmö, Schweden.
Handchir Mikrochir Plast Chir. 2003 Jul;35(4):225-32. doi: 10.1055/s-2003-42128.
Breast cancer is the most common disease in women, and up to 38 % develop lymphoedema of the arm following mastectomy, standard axillary node dissection and postoperative irradiation. Limb reductions have been reported utilising various conservative therapies such as manual lymph drainage and pressure therapy. Some patients with long-standing pronounced lymphoedema do not respond to these conservative treatments because slow or absent lymph flow causes the formation of excess subcutaneous adipose tissue. Previous surgical regimes utilising bridging procedures, total excision with skin grafting or reduction plasty seldom achieved acceptable cosmetic and functional results. Microsurgical reconstruction involving lympho-venous shunts or transplantation of lymph vessels has also been investigated. Although attractive in concept, the common failure of microsurgery to provide complete reduction is due to the persistence of newly formed subcutaneous adipose tissue which is not removed in patients with chronic non-pitting lymphoedema. Liposuction removes the hypertrophied adipose tissue and is a prerequisite to achieve complete reduction. The new equilibrium is maintained through constant (24-hour) use of compression garments postoperatively. Long-term follow-up (seven years) does not show any recurrence of the oedema.
乳腺癌是女性最常见的疾病，高达38%的患者在乳房切除、标准腋窝淋巴结清扫及术后放疗后会出现手臂淋巴水肿。据报道，采用各种保守疗法，如手法淋巴引流和压力疗法，可减轻肢体肿胀。一些长期存在明显淋巴水肿的患者对这些保守治疗无反应，因为淋巴流动缓慢或缺失会导致皮下脂肪组织过多形成。以往采用搭桥手术、带皮瓣全切除或整形手术的治疗方案很少能取得可接受的美容和功能效果。也有人研究了涉及淋巴管静脉分流或淋巴管移植的显微外科重建手术。尽管从概念上讲很有吸引力，但显微手术通常无法实现完全消肿，原因是慢性非凹陷性淋巴水肿患者新形成的皮下脂肪组织持续存在，无法清除。抽脂可去除肥厚的脂肪组织，是实现完全消肿的前提条件。术后持续（24小时）使用加压服装可维持新的平衡。长期随访（七年）未发现水肿复发。
