Kareh Aurora M, Xu Kyle Y
Aurora M. Kareh, MD, is a Resident Physician, Division of Plastic and Reconstructive Surgery, and Kyle Y. Xu, MD, is an Attending Physician, Plastic Surgery, Microsurgery and Hand Surgery, Division of Plastic and Reconstructive Surgery, Department of Surgery, Saint Louis University School of Medicine, St. Louis, Missouri.
Mo Med. 2020 Mar-Apr;117(2):143-148.
Lymphedema is a chronic debilitating disease in which impaired drainage of lymphatic fluid causes accumulation of fluid in the soft tissues resulting in a swollen heavy limb. This ultimately leads to severe fibrosis, recurrent infections, non-healing wounds, and a poorly functioning limb that negatively affects a patient's quality of life. Primary lymphedema is due to abnormal development of the lymphatic system and patients can present with lymphedema at birth or later in life. Secondary lymphedema is caused by damage to the lymphatic system from infection, surgery to treat malignancies, trauma, and obesity. In the past, the only treatment was controlling the swelling to prevent progression of the disease by lymphatic therapy and various types of compression which is still currently the first line treatment. Advances in supermicrosurgery (connecting vessels less than 0.8 mm) have made way for surgical treatment options for lymphedema, including lymphovenous bypass and vascularized lymph node transplant. These new surgical treatment options combined with lymphatic therapy and compression have led to better results and improved patient's quality of life. After reading this article, the participant should be familiar with diagnosis, imaging, and surgical treatment of lymphedema.
淋巴水肿是一种慢性致残性疾病，其中淋巴液引流受损导致软组织中液体积聚，从而使肢体肿胀沉重。这最终会导致严重的纤维化、反复感染、伤口不愈合以及肢体功能不佳，对患者的生活质量产生负面影响。原发性淋巴水肿是由于淋巴系统发育异常引起的，患者可能在出生时或生命后期出现淋巴水肿。继发性淋巴水肿是由感染、治疗恶性肿瘤的手术、创伤和肥胖对淋巴系统造成的损害引起的。过去，唯一的治疗方法是通过淋巴治疗和各种类型的加压来控制肿胀，以防止疾病进展，目前这仍然是一线治疗方法。超显微外科手术（连接小于0.8毫米的血管）的进展为淋巴水肿的手术治疗选择开辟了道路，包括淋巴静脉旁路手术和带血管蒂淋巴结移植。这些新的手术治疗选择与淋巴治疗和加压相结合，取得了更好的效果，提高了患者的生活质量。阅读本文后，参与者应熟悉淋巴水肿的诊断、影像学检查和手术治疗。
