Lee B B, Kim Y W, Kim D I, Hwang J H, Laredo J, Neville R
Department of Surgery, Georgetown University, Washington DC, USA.
Int Angiol. 2008 Oct;27(5):389-95.
When the lymphedema reaches to its end stages, the complex decongestive therapy (CDT) and/or compression therapy become less effective and increased risk of systemic/general sepsis to become potentially life threatening condition.
To improve its clinical management, excisional surgery was performed on 22 patients for their 33 limbs in the end stage of lymphedema as a supplemental therapy, and its efficacy was retrospectively analyzed. Diagnosis was made by radionuclide lymphoscintigraphy and basic laboratory studies (e.g. ultrasonography, magnetic resonance imaging). Twenty-two patients (mean age: 46 years; 3 male and 19 female; 5 primary and 17 secondary) submitted to the excisional surgery on 33 limbs (unilateral: 11; bilateral: 22). Surgery was indicated by further progression of the disease with recurrent sepsis despite adequate antibiotics therapy. A modified Auchincloss-Homan's operation was used to excise grotesquely disfigured soft tissue with advanced dermato-lipo-fibrosclerotic change. The normal limb contour was re-established to allow proper postoperative therapy. Postoperative CDT and compression therapy were mandatorily implemented in all cases.
A postoperative assessment of the treatment results, at 12 months showed an overall improvement in 28 of the 33 limbs: substantial improvement on the condition of limb function and quality of life (QOL), and local and/or systemic sepsis. Eighteen patients with good compliance to maintain the postoperative CDT showed much improved clinical results and QOL through the first interim assessment (24 months).
Excisional surgery at the end stage of lymphedema seems to provide substantial improvement of clinical condition and QOL only when mandated postoperative CDT/compression therapy is well kept.
当淋巴水肿发展至终末期时，综合消肿治疗（CDT）和/或压迫治疗效果欠佳，且全身/全身性脓毒症风险增加，可能危及生命。
为改善临床治疗效果，对22例患者的33条肢体进行了切除手术，作为淋巴水肿终末期的补充治疗，并对其疗效进行回顾性分析。通过放射性核素淋巴闪烁造影和基础实验室检查（如超声、磁共振成像）进行诊断。22例患者（平均年龄46岁；男性3例，女性19例；原发性5例，继发性17例）的33条肢体接受了切除手术（单侧11条；双侧22条）。尽管进行了充分的抗生素治疗，但疾病仍进一步发展并反复出现脓毒症，提示需进行手术。采用改良的奥金克洛斯-霍曼手术切除严重变形的软组织，这些软组织已出现晚期皮肤-脂肪-纤维硬化改变。重建正常的肢体轮廓，以便进行适当的术后治疗。所有病例均强制实施术后CDT和压迫治疗。
术后12个月对治疗效果进行评估，结果显示33条肢体中有28条整体情况有所改善：肢体功能状况、生活质量（QOL）以及局部和/或全身脓毒症均有显著改善。18例患者术后严格遵守CDT，通过首次中期评估（24个月），临床效果和QOL有明显改善。
只有在严格遵守术后CDT/压迫治疗的情况下，淋巴水肿终末期的切除手术似乎才能显著改善临床状况和QOL。
