Hunter and New England Health Area, Manning Hospital, 26 YORK Street, Taree, NSW 2430, Australia.
Surg Oncol. 2011 Jun;20(2):88-96. doi: 10.1016/j.suronc.2009.11.003. Epub 2009 Dec 11.
Inguinal nodes dissection is associated with high rates of morbidity, lymphedema in particular is a chronic disabling condition which is a common complication following this operation. Prevention or minimization of this condition is an important aim when considering this procedure. Many technical modifications are suggested for this purpose. This systematic review aims at assessing the efficacy of the available strategies to reduce the risk and severity of leg lymphedema.
For this review, MEDLINE and EMBASE were searched to identify studies that reported surgical strategies designed to reduce complications of groin dissection and in particular leg lymphedema. Studies that reported outcome of long saphenous vein sparing, fascia preserving dissection, microvascular surgery, sartorius transposition and omental pedicle flap were located. Data were collected using predefined inclusion and exclusion criteria. A combined odds ratio was calculated combining studies suitable for meta-analysis using the random effect model.
The search result defined few studies that reported results of saphenous vein sparing technique; some of those studies were found suitable for meta-analysis based on the Newcastle-Ottawa scale for non-randomized studies. The meta-analysis showed significant reduction of lymphedema (odds ratio 0.24, 95% CI 0.11-0.53) and other complications of inguinal node dissection. There were no randomized studies to address this problem; there are also isolated studies that reported benefits of other techniques but none of them was suitable for meta-analysis.
Meta-analysis of the reported studies on sparing the long saphenous vein in inguinal nodes dissection suggests a reduced rate of lymphedema and other postoperative complications. Other methods that may be beneficial are fascia preserving dissection, pedicled omental flap and microsurgery; however sartorius transposition has not been shown to reduce the rate of complications. Randomized controlled trials are needed to prove the benefits of various technical modifications.
腹股沟淋巴结清扫术与高发病率相关，尤其是淋巴水肿，这是一种慢性致残疾病，是该手术后的常见并发症。在考虑进行此手术时，预防或最小化这种情况是一个重要目标。为此目的提出了许多技术修改。本系统评价旨在评估现有的降低腿部淋巴水肿风险和严重程度的策略的疗效。
为了进行这项综述，检索了 MEDLINE 和 EMBASE，以确定报告旨在降低腹股沟清扫术并发症，特别是腿部淋巴水肿风险的手术策略的研究。定位了报道长隐静脉保留、筋膜保留解剖、微血管手术、缝匠肌移位和网膜蒂皮瓣结果的研究。使用预定义的纳入和排除标准收集数据。使用随机效应模型对适合进行荟萃分析的研究进行合并计算合并优势比。
搜索结果定义了一些报道隐静脉保留技术结果的研究；根据针对非随机研究的纽卡斯尔-渥太华量表，其中一些研究被发现适合进行荟萃分析。荟萃分析显示，腹股沟淋巴结清扫术的淋巴水肿（优势比 0.24，95%置信区间 0.11-0.53）和其他并发症显著减少。没有随机研究来解决这个问题；也有一些单独的研究报告了其他技术的益处，但没有一项适合进行荟萃分析。
对腹股沟淋巴结清扫术中保留长隐静脉的报告研究进行荟萃分析表明，淋巴水肿和其他术后并发症的发生率降低。其他可能有益的方法包括筋膜保留解剖、带蒂网膜瓣和显微手术；然而，缝匠肌移位并未显示出降低并发症发生率的效果。需要随机对照试验来证明各种技术修改的益处。
