Lee B B, Laredo J, Neville R
Division of Vascular Surgery, Georgetown University School of Medicine, Washington, DC, USA.
Vascular. 2011 Aug;19(4):195-205. doi: 10.1258/vasc.2010.oa0287. Epub 2011 Jul 22.
The aim of the paper is to assess the efficacy of reconstructive lymphatic surgery in the treatment of chronic lymphedema via retrospective analysis. Lymphovenous anastomotic surgery (LVAS) or free lymph node transplant surgery (FLTS) was performed on 32 patients who failed to respond to complex decongestive therapy (CDT) alone for a minimum of a one-year period. In LVAS, three patients with good compliance among 19 were able to maintain initial improvement through the four-year follow-up period. All three had secondary lymphedema in clinical stage II. In FLTS, among 13 patients, three compliant patients with the secondary lymphedema in clinical stage II kept initial improvement through the four-year follow-up. In conclusion, reconstructive lymphatic surgery (LVAS and FLTS) appears to be more effective in secondary lymphedema versus primary lymphedema when performed in the early stages. Patient compliance to maintain CDT postoperatively remains the most critical factor in maintaining durable long-term results. FLTS seems to have an additional risk involved to the donor lymph node harvest and a limited role compared to LVAS. Further extended study on FLTS is required to demonstrate its efficacy compared with LVAS.
本文旨在通过回顾性分析评估重建性淋巴手术治疗慢性淋巴水肿的疗效。对32例单纯综合消肿治疗（CDT）至少1年无效的患者进行了淋巴静脉吻合手术（LVAS）或游离淋巴结移植手术（FLTS）。在LVAS组中，19例患者中有3例依从性良好，在四年随访期内能够维持最初的改善情况。这3例患者临床分期均为继发性淋巴水肿II期。在FLTS组中，13例患者中有3例依从性良好，其继发性淋巴水肿临床分期为II期，在四年随访期内维持了最初的改善情况。总之，重建性淋巴手术（LVAS和FLTS）在早期进行时，治疗继发性淋巴水肿似乎比原发性淋巴水肿更有效。患者术后坚持进行CDT仍是维持持久长期疗效的最关键因素。FLTS似乎在供体淋巴结采集方面存在额外风险，与LVAS相比作用有限。需要对FLTS进行进一步的扩展研究，以证明其与LVAS相比的疗效。
