te Slaa A, Dolmans D E J G J, Ho G H, Moll F L, van der Laan L
Department of Surgery, Amphia Hospital, Breda, The Netherlands.
Vascular. 2012 Dec;20(6):350-9. doi: 10.1258/vasc.2011.ra0055. Epub 2012 Sep 14.
Substantial lower-limb edema affects the majority of patients who undergo peripheral bypass surgery. Edema has impairing effects on the microvascular and the macrovascular circulation, causes discomfort and might delay the rehabilitation process of the patient. However, the pathophysiology of this edema is not well understood. The Cochrane Library and Medline were used to retrieve literature on edema following peripheral bypass surgery. Factors other than local wound healing alone are suggested in the literature to play a role, given the severity and duration of this edema. Hyperemia, microvascular permeability, reperfusion-associated inflammation and lymphatic disruptions are likely to facilitate the development of edema. Preventive methods could be lymphatic-sparing surgery, intraoperative antioxidative therapy and postoperative elevation. Successful treatment strategies to reduce postoperative edema are based on lymph massage and external compression. In conclusion, the pathophysiology of edema following peripheral surgery is not fully understood, although reperfusion-associated inflammation and lymphatic disruptions are likely to play a crucial role. When future less-invasive techniques prove to be successful, postoperative edema might be minimized. Until then, a careful lymphatic-sparing dissection should be executed when performing a peripheral bypass reconstruction. Postoperatively, the use of compression stockings and leg elevation are currently the golden standards.
大量下肢水肿影响大多数接受外周血管搭桥手术的患者。水肿对微血管和大血管循环有损害作用，会引起不适，并可能延迟患者的康复进程。然而，这种水肿的病理生理学尚未得到充分了解。通过Cochrane图书馆和医学期刊数据库检索外周血管搭桥手术后水肿的相关文献。鉴于这种水肿的严重程度和持续时间，文献表明除了局部伤口愈合之外的其他因素也起作用。充血、微血管通透性、再灌注相关炎症和淋巴系统破坏可能促进水肿的发展。预防方法可以是保留淋巴管的手术、术中抗氧化治疗和术后抬高患肢。减轻术后水肿的成功治疗策略基于淋巴按摩和外部加压。总之，尽管再灌注相关炎症和淋巴系统破坏可能起关键作用，但外周血管手术后水肿的病理生理学尚未完全了解。当未来的微创技术被证明成功时，术后水肿可能会降至最低。在此之前，进行外周血管搭桥重建手术时应仔细进行保留淋巴管的解剖。术后，使用弹力袜和抬高腿部目前是黄金标准。
