Campisi Corradino, Boccardo Francesco
Department of Specialistic Surgical Sciences, Anesthesiology, and Organ Transplants, Section of General and Emergency Surgery, Lymphology and Microsurgery Center, S. Martino Hospital, University of Genoa, Genoa, Italy.
World J Surg. 2004 Jun;28(6):609-13. doi: 10.1007/s00268-004-7252-4.
We analyzed clinicopathologic and imaging features of chronic peripheral lymphedema to identify imaging findings indicative of its exact etiopathogenesis and to establish the optimal treatment strategy. One of the main problems of microsurgery for lymphedema is the discrepancy between the excellent technical possibilities and the subsequently insufficient reduction of the lymphedematous tissue fibrosis and sclerosis. Appropriate treatment based on pathologic studies and surgical outcome have not been adequately documented. Over the past 25 years, 676 patients with peripheral lymphedema have been treated with microsurgical lymphatic-venous anastomoses. Of these patients, 447 (66%) were available for long-term follow-up study. Objective assessment was undertaken by water volumetry and lymphoscintigraphy. Objectively, volume changes showed a significant improvement in 561 patients (83%), with an average reduction of 67% of the excess volume. Of the 447 patients followed, 380 (85%) have been able to discontinue the use of conservative measures, with an average follow-up of more than 7 years and average reduction in excess volume of 69%. There was an 87% reduction in the incidence of cellulitis after microsurgery. Microsurgical lymphatic-venous anastomoses have a place in the treatment of peripheral lymphedema and should be the therapy of choice in patients who are not sufficiently responsive to nonsurgical treatment. Improved results can be expected with operations performed early, during the first stages of lymphedema.
我们分析了慢性周围性淋巴水肿的临床病理和影像学特征，以确定能够提示其确切病因发病机制的影像学表现，并制定最佳治疗策略。淋巴水肿显微外科手术的主要问题之一是，尽管技术上有很大可能性，但随后淋巴水肿组织纤维化和硬化的减轻却不充分。基于病理研究和手术结果的恰当治疗尚未得到充分记录。在过去25年中，676例周围性淋巴水肿患者接受了显微外科淋巴静脉吻合术治疗。其中447例（66%）可进行长期随访研究。通过水容积测量法和淋巴闪烁造影术进行客观评估。客观上，561例患者（83%）的体积变化有显著改善，多余体积平均减少67%。在接受随访的447例患者中，380例（85%）能够停止使用保守治疗措施，平均随访时间超过7年，多余体积平均减少69%。显微外科手术后蜂窝织炎的发生率降低了87%。显微外科淋巴静脉吻合术在周围性淋巴水肿的治疗中占有一席之地，对于非手术治疗反应不充分的患者应作为首选治疗方法。在淋巴水肿的第一阶段尽早进行手术，有望取得更好的效果。
