Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Ann Surg Oncol. 2012 Feb;19(2):642-51. doi: 10.1245/s10434-011-2017-4. Epub 2011 Aug 24.
A systematic review of the literature was performed to examine contemporary peer-reviewed literature (2004-2010) evaluating the surgical treatment of lymphedema.
A comprehensive search of 11 major medical indices was performed. Selected articles were sorted to identify those related to the surgical treatment of lymphedema. Extracted data included the number of patients, specific surgical procedure performed, length of follow-up, criteria for defining lymphedema, measurement methods, volume or circumference reduction, and reported complications.
A total of 20 studies met inclusion criteria; procedures were categorized as excisional procedures (n = 8), lymphatic reconstruction (n = 8), and tissue transfer (n = 4). The reported incidence of volume reduction of lymphedema in these studies varied from 118% reduction to a 13% increase over the follow-up intervals ranging from 6 months to 15 years. The largest reported reductions were noted after excisional procedures (91.1%), lymphatic reconstruction (54.9%), and tissue transfer procedures (47.6%). Procedure complications were rarely reported.
A number of surgical approaches have demonstrated beneficial effects for select patients with lymphedema. Most of these reports, however, are based on small numbers of patients, use nonstandardized or inconsistent measurement techniques, and lack long-term follow-up. The proposed benefits of any surgical approach should be evaluated in the context of the potential morbidity to the individual patient and the availability of surgical expertise. In addition, although these surgical techniques have shown promising results, nearly all note that the procedures do not obviate the need for continued use of conventional therapies, including compression, for long-term maintenance.
对 2004 年至 2010 年间的当代同行评议文献进行系统评价，以评估淋巴水肿的手术治疗。
对 11 个主要医学索引进行了全面检索。对选定的文章进行分类，以确定与淋巴水肿手术治疗相关的文章。提取的数据包括患者数量、实施的具体手术、随访时间、淋巴水肿定义标准、测量方法、体积或周长减少以及报告的并发症。
共有 20 项研究符合纳入标准；手术分为切除性手术（n = 8）、淋巴重建术（n = 8）和组织转移术（n = 4）。这些研究报告的淋巴水肿体积减少率从随访时间为 6 个月至 15 年的 118%减少到 13%不等。切除性手术（91.1%）、淋巴重建术（54.9%）和组织转移术（47.6%）的减少率最大。很少有报告手术并发症。
一些手术方法对某些淋巴水肿患者有有益的效果。然而，这些报告中的大多数都基于少数患者，使用非标准化或不一致的测量技术，并且缺乏长期随访。任何手术方法的潜在益处都应根据对个体患者的潜在发病率和手术专业知识的可用性进行评估。此外，尽管这些手术技术显示出有希望的结果，但几乎所有的手术技术都指出，这些程序并不能消除对长期维持的常规治疗（包括压缩）的需求。
