Lee B B, Laredo J, Neville R
Division of Vascular Surgery, Department of Surgery, George Washington University School of Medicine, Washington, D.C.
Int J Angiol. 2011 Jun;20(2):73-80. doi: 10.1055/s-0031-1279685.
The goal of reconstructive lymphatic surgery is to restore normal lymphatic function to "cure" permanently the lymphedematous limb in patients with lymphedema. In reality, reconstructive surgery remains an adjunctive treatment at best, with its current indication being refractory lymphedema in patients treated with complex decongestive therapy (CDT) alone. The role of reconstructive lymphatic surgery remains controversial and is far from being accepted as standard independent therapy because of multiple reasons. However, reconstructive surgery appears to be most effective in controlling the progression of lymphedema during the early stages when the paralyzed lymph vessels are still able to function and recover. Our experience in reconstructive surgery has shown that improved long-term results are dependent on prolonged patient compliance with maintenance CDT and the prevention and treatment of infection. To better understand the role of reconstructive surgery in the management of chronic lymphedema, well-constructed clinical trials based on well-organized multicenter studies with similar protocols are mandated. For the future, it remains the only possible treatment method capable of providing a cure.
重建性淋巴外科手术的目标是恢复正常淋巴功能，从而永久性地“治愈”淋巴水肿患者的患肢。实际上，重建性手术充其量仍只是一种辅助治疗手段，其目前的适应症是仅接受了综合消肿治疗（CDT）的难治性淋巴水肿患者。由于多种原因，重建性淋巴外科手术的作用仍存在争议，远未被接受为标准的独立治疗方法。然而，当麻痹的淋巴管仍能发挥功能并恢复时，重建性手术在早期阶段似乎最有效地控制了淋巴水肿的进展。我们的重建性手术经验表明，长期效果的改善取决于患者长期坚持维持性CDT以及预防和治疗感染。为了更好地理解重建性手术在慢性淋巴水肿管理中的作用，必须开展基于组织良好、方案相似的多中心研究的精心设计的临床试验。从未来来看，它仍然是唯一有可能实现治愈的治疗方法。
