Lee B B, Bergan J J
Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
Lymphology. 2005 Sep;38(3):122-9.
We have developed new clinical (C) and laboratory (L) staging systems to improve the clinical management of chronic lymphedema. These systems were retrospectively assessed in 220 chronic lymphedema patients followed up for 4 years. Clinical evaluation of the treatment response/disease progression was performed at 6 month intervals and laboratory evaluation at a yearly interval except for recurrent sepsis cases. The reliability of C-stage and L-stage for the progression of disease were analyzed separately. The C-staging was based on the subjective and objective findings of local and systemic conditions, while L-staging was based on lymphoscintigraphicfindings. Clinical implementation of this new staging system facilitated interpretation of the progress/deterioration of the clinical response to CDT treatment, and it was found to be a useful guideline for the decision/selection of further surgical treatment. We propose that these two separate staging systems could now become a new guideline for improved management of lymphedema with a better prediction of treatment outcome and decision point for additional medical/surgical therapy. Further clinical implementation and evaluation is necessary to demonstrate clinical usefulness especially to guide surgical therapy and L-staging in followup.
我们开发了新的临床（C）和实验室（L）分期系统，以改善慢性淋巴水肿的临床管理。对220例慢性淋巴水肿患者进行了为期4年的随访，对这些系统进行了回顾性评估。除复发性败血症病例外，每6个月进行一次治疗反应/疾病进展的临床评估，每年进行一次实验室评估。分别分析了C期和L期对疾病进展的可靠性。C分期基于局部和全身状况的主观和客观发现，而L分期基于淋巴闪烁造影结果。这种新分期系统的临床应用有助于解释CDT治疗临床反应的进展/恶化情况，并且发现它是进一步手术治疗决策/选择的有用指南。我们建议，这两个独立的分期系统现在可以成为改善淋巴水肿管理的新指南，能够更好地预测治疗结果以及额外药物/手术治疗的决策点。需要进一步的临床应用和评估来证明其临床实用性，特别是在随访中指导手术治疗和L分期。
