Lim Kah Heng Alexander, Speare Rick, Thomas Gail, Graves Patricia
College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia.
The Carter Center, One Copenhill, Atlanta, GA, USA.
World J Surg. 2015 Dec;39(12):2885-99. doi: 10.1007/s00268-015-3220-4.
Genital manifestations of lymphatic filariasis (genital LF) are a significant cause of disfigurement and disability in the developing world. Surgery is the standard treatment; however, definitive publications are lacking and best practice remains unclear. An exhaustive search strategy using keyword and subject headings was applied to Medline, EMBASE, Web of Science, CINAHL, and Scopus. Additionally citation lists, Google and Google Scholar, archives of relevant journals and websites were searched systematically. Studies with data on one or more human patient(s) who underwent surgery for genital LF were included. Articles were screened and data extracted by the first author with data verification by the second author. Fifty-seven studies were included: 18 series of ablative surgery, four series of non-ablative surgery and 35 case reports. Poor study quality, heterogeneous case definitions, lack of severity grading and limited follow-up precluded meta-analysis. Two series of simple hydrocelectomies performed in resource-limited settings reported early complication rates of 3.0-3.5 % using eversion and 5-7 % using excision, with recurrence of 7 % and 3-5 %, respectively. Complications were minimal for single-surgeon series and greater (12-18 %) when scrotal reconstruction was performed. There is little useful evidence for lymphatic bypass procedures in genital LF. Under-recognition of atypical manifestation of genital LF leads to potentially unnecessary surgeries. Surgery for genital LF is safe in resource-limited settings; however, more well-designed studies with better follow-up are needed. Research priorities include validation of case definitions and severity grading systems, and solutions to improve post-operative follow-up in resource-limited settings.
淋巴丝虫病的生殖系统表现（生殖器淋巴丝虫病）是发展中世界致残和毁容的重要原因。手术是标准治疗方法；然而，缺乏权威性的出版物，最佳实践仍不明确。我们采用关键词和主题词的详尽检索策略，对医学文献数据库（Medline）、荷兰医学文摘数据库（EMBASE）、科学引文索引数据库（Web of Science）、护理学与健康领域数据库（CINAHL）和Scopus数据库进行检索。此外，还系统检索了参考文献列表、谷歌和谷歌学术、相关期刊和网站的存档。纳入了一项或多项接受生殖器淋巴丝虫病手术的人类患者数据的研究。文章由第一作者进行筛选和数据提取，并由第二作者进行数据核实。共纳入57项研究：18项根治性手术系列研究、4项非根治性手术系列研究和35项病例报告。研究质量差、病例定义不统一、缺乏严重程度分级以及随访有限，妨碍了进行荟萃分析。在资源有限的环境中进行的两项单纯鞘膜积液切除术系列研究报告，外翻法的早期并发症发生率为3.0-3.5%，切除法为5-7%，复发率分别为7%和3-5%。单术者系列手术的并发症最少，进行阴囊重建时并发症较多（12-18%）。关于生殖器淋巴丝虫病的淋巴分流手术，几乎没有有用的证据。对生殖器淋巴丝虫病非典型表现的认识不足会导致潜在的不必要手术。在资源有限的环境中，生殖器淋巴丝虫病手术是安全的；然而，需要更多设计更好且随访更佳的研究。研究重点包括验证病例定义和严重程度分级系统，以及解决在资源有限的环境中改善术后随访的问题。
