From the University of Chicago Medicine and Biological Sciences; Memorial Sloan Kettering Cancer Center; Boston Children's Hospital; University of Western Ontario; Sant Pau Hospital; University of Washington Medical Center; and Stanford University Medical Center.
Plast Reconstr Surg. 2021 Apr 1;147(4):975-993. doi: 10.1097/PRS.0000000000007783.
The goal of this consensus conference, sponsored by the American Association of Plastic Surgeons, was to perform a systematic review and meta-analysis of controlled trials to examine both the benefits and risks of surgical treatment and surgical prevention of upper and lower extremity lymphedema.
The panel met in Boston for a 3-day, face-to-face meeting in July of 2017. After an exhaustive review of the existing literature, the authors created consensus recommendations using the Grading of Recommendations, Assessment, Development and Evaluation criteria. Important directions for future research were also identified.
There is evidence to support that lymphovenous anastomosis can be effective in reducing severity of lymphedema (grade 1C). There is evidence to support that vascular lymph node transplantation can be effective in reducing severity of lymphedema (grade 1B). Currently, there is no consensus on which procedure (lymphovenous bypass versus vascular lymph node transplantation) is more effective (grade 2C). A few studies show that prophylactic lymphovenous bypass in patients undergoing extremity lymphadenectomy may reduce the incidence of lymphedema (grade 1B). More studies with longer follow-up are required to confirm this benefit. Debulking procedures such as liposuction are effective in addressing a nonfluid component such as fat involving lymphedema (grade 1C). There is a role for liposuction combined with physiologic procedures although the timing of each procedure is currently unresolved (grade 1C).
Many studies seem to support some efficacy of lymphovenous bypass and vascular lymph node transplantation. Many studies show the important role of lymphedema therapy and other procedures such as liposuction and debulking. The management of lymphedema is a challenging field with many promising advances. However, many questions remain unanswered.
本次共识会议由美国整形外科学会主办，旨在对对照试验进行系统回顾和荟萃分析，以检查上肢和下肢淋巴水肿的手术治疗和手术预防的益处和风险。
专家组于 2017 年 7 月在波士顿举行了为期 3 天的面对面会议。在对现有文献进行详尽审查后，作者使用推荐分级、评估、制定和评估标准制定了共识建议。还确定了未来研究的重要方向。
有证据支持淋巴静脉吻合术可有效减轻淋巴水肿的严重程度（1C 级）。有证据支持血管淋巴结移植可有效减轻淋巴水肿的严重程度（1B 级）。目前，对于哪种手术（淋巴静脉旁路术与血管淋巴结移植术）更有效尚无共识（2C 级）。一些研究表明，在接受四肢淋巴结切除术的患者中预防性行淋巴静脉旁路术可能会降低淋巴水肿的发生率（1B 级）。需要更多具有更长随访时间的研究来证实这一益处。吸脂等整形手术可有效解决淋巴水肿中的非液体成分，如脂肪（1C 级）。吸脂术联合生理治疗有一定作用，尽管目前尚不清楚每种手术的时机（1C 级）。
许多研究似乎支持淋巴静脉旁路术和血管淋巴结移植术的某些疗效。许多研究表明，淋巴水肿治疗和其他手术如吸脂术和切除术等在治疗淋巴水肿中具有重要作用。淋巴水肿的治疗是一个具有许多有前途进展的具有挑战性的领域。然而，仍有许多问题悬而未决。
