Lymphology. 2016 Dec;49(4):170-84.
This International Society of Lymphology (ISL) Consensus Document is the latest revision of the 1995 Document for the evaluation and management of peripheral lymphedema (1). It is based upon modifications: [A] suggested and published following the 1997 XVI International Congress of Lymphology (ICL) in Madrid, Spain (2), discussed at the 1999 XVII ICL in Chennai, India (3), and considered/ confirmed at the 2000 (ISL) Executive Committee meeting in Hinterzarten, Germany (4); [B] derived from integration of discussions and written comments obtained during and following the 2001 XVIII ICL in Genoa, Italy as modified at the 2003 ISL Executive Committee meeting in Cordoba, Argentina (5); [C] suggested from comments, criticisms, and rebuttals as published in the December 2004 issue of Lymphology (6); [D] discussed in both the 2005 XX ICL in Salvador, Brazil and the 2007 XXI ICL in Shanghai, China and modified at the 2008 Executive Committee meeting in Naples, Italy (7,8);[E] modified from discussions and written comments from the 2009 XXII ICL in Sydney, Australia, the 2011 XXIII ICL in Malmö, Sweden, the 2012 Executive Committee Meetings (9),and [F] from discussions at the 2013 XXIV ICL in Rome, Italy, and the 2015 XXV ICL in San Francisco, USA, as well as multiple written comments and feedback from Executive Committee and other ISL members during the 2016 drafting. The document attempts to amalgamate the broad spectrum of protocols and practices advocated worldwide for the diagnosis and treatment of peripheral lymphedema into a coordinated proclamation representing a “Consensus” of the international community based on various levels of evidence. The document is not meant to override individual clinical considerations for complex patients nor to stifle progress. It is also not meant to be a legal formulation from which variations define medical malpractice. The Society understands that in some clinics the method of treatment derives from national standards while in others access to medical equipment and supplies is limited; therefore the suggested treatments might be impractical. Adaptability and inclusiveness does come at the price that members can rightly be critical of what they see as vagueness or imprecision in definitions, qualifiers in the choice of words (e.g., the use of “may... perhaps... unclear”, etc.) and mentions (albeit without endorsement) of treatment options supported by limited hard data. Most members are frustrated by the reality that NO treatment method has really undergone a satisfactory meta-analysis (let alone rigorous, randomized, stratified, long-term, controlled study). With this understanding, the absence of definitive answers and optimally conducted clinical trials, and with emerging technologies and new approaches and discoveries on the horizon, some degree of uncertainty, ambiguity, and flexibility along with dissatisfaction with current lymphedema evaluation and management is appropriate and to be expected. We continue to struggle to keep the document concise while balancing the need for depth and details. With these considerations in mind, we believe that this 2016 version presents a Consensus that embraces the entire ISL membership, rises above national standards, identifies and stimulates promising areas for future research, and represents the best judgment of the ISL membership on how to approach patients with peripheral lymphedema in the light of currently available evidence. Therefore, the document has been, and should continue to be, challenged and debated in the pages of Lymphology (e.g., as Letters to the Editor) and ideally will remain a continued focal point for robust discussion at local, national and international conferences in lymphology and related disciplines. We further anticipate as experience evolves and new ideas and technologies emerge that this “living document” will undergo further periodic revision and refinement as the practice and conceptual foundations of medicine and specifically lymphology change and advance.
本国际淋巴学会（ISL）共识文件是1995年《外周性淋巴水肿评估与管理文件》的最新修订版（1）。它基于以下修改：[A] 1997年在西班牙马德里召开的第十六届国际淋巴学大会（ICL）后提出并发表的建议（2），1999年在印度金奈召开的第十七届ICL上进行了讨论（3），并在2000年德国欣特察尔滕召开的（ISL）执行委员会会议上得到审议/确认（4）；[B] 源自2001年在意大利热那亚召开的第十八届ICL期间及之后获得的讨论和书面意见的整合，并在2003年阿根廷科尔多瓦召开的ISL执行委员会会议上进行了修改（5）；[C] 来自2004年12月《淋巴学》杂志上发表的评论、批评和反驳意见（6）；[D] 在2005年巴西萨尔瓦多召开的第二十届ICL和2007年中国上海召开的第二十一届ICL上进行了讨论，并在2008年意大利那不勒斯召开的执行委员会会议上进行了修改（7,8）；[E] 根据2009年澳大利亚悉尼召开的第二十二届ICL、2011年瑞典马尔默召开的第二十三届ICL、2012年执行委员会会议的讨论和书面意见进行了修改（9），以及[F] 根据2013年意大利罗马召开的第二十四届ICL和2015年美国旧金山召开的第二十五届ICL的讨论，以及在2016年起草过程中执行委员会和其他ISL成员的多次书面意见和反馈进行了修改。该文件试图将全球范围内倡导的用于外周性淋巴水肿诊断和治疗的广泛方案和实践整合为一份协调一致的声明，代表基于不同证据水平的国际社会“共识”。该文件并非旨在取代针对复杂患者的个体临床考量，也无意抑制进展。它也不是一种法律规定，据此差异来界定医疗过失。学会明白，在一些诊所，治疗方法源自国家标准，而在另一些诊所，获取医疗设备和用品受到限制；因此，建议的治疗方法可能不切实际。适应性和包容性确实存在代价，成员们可能会正确地批评他们认为定义中的模糊性或不精确性、用词选择中的限定词（例如使用“可能……或许……不明确”等）以及对有限确凿数据支持的治疗选择的提及（尽管未获认可）。由于没有一种治疗方法真正经过令人满意的荟萃分析（更不用说严格的、随机的、分层的、长期的、对照研究），大多数成员对这一现实感到沮丧。基于这种理解，缺乏明确答案和最佳实施的临床试验，以及随着新技术、新方法和新发现的出现，一定程度的不确定性、模糊性和灵活性以及对当前淋巴水肿评估和管理的不满是适当的且可以预料的。我们继续努力在保持文件简洁的同时，平衡深度和细节的需求。考虑到这些因素，我们相信2016年版呈现了一种涵盖整个ISL成员的共识，超越了国家标准，确定并激发了未来研究的有前景领域，并代表了ISL成员根据当前可得证据对如何处理外周性淋巴水肿患者的最佳判断。因此，该文件已经并应继续在《淋巴学》杂志的页面上受到挑战和辩论（例如作为给编辑的信），理想情况下，它将继续成为淋巴学及相关学科的地方、国家和国际会议上热烈讨论的焦点。我们进一步预计，随着经验的积累以及新思想和新技术的出现，随着医学尤其是淋巴学的实践和概念基础的变化与发展，这份“动态文件”将经历进一步的定期修订和完善。
