Despite our improved knowledge of the lymphatic system, lymphedema remains an incurable disease. Its pathogenesis is still poorly understood, but fortunately the majority of patients can be satisfactorily managed by conservative means. Surgical intervention is offered only in cases of refractory disease and does not offer a surgical cure. At the present time, there are five major surgical options: lymphangioplasty, buried dermal flap, lymphaticovenous shunts, the Charles procedure, and the staged subcutaneous excision beneath flaps. Lymphangioplasty is usually limited to those patients with limited life expectancy, because the beneficial effects are transient. The most frequently used procedures--the buried dermal flap, the Charles procedure, and the subcutaneous excision beneath flaps--offer patients symptomatic improvement, primarily through the excision of lymphedematous subcutaneous tissue. Much controversy still exists as to the efficacy and future applicability of both the enteromesenteric bridge and microlymphatic surgery, which are currently under investigation. Long-term follow-up will be necessary. The discouraging fact remains that no procedure cures lymphedemia; however, we believe that, at this time, the subcutaneous excision beneath skin flaps offers the most reliable and consistently beneficial means of surgically managing the symptoms of lymphedema.
尽管我们对淋巴系统的认识有所提高，但淋巴水肿仍然是一种无法治愈的疾病。其发病机制仍未完全明了，但幸运的是，大多数患者可通过保守方法得到满意的治疗。仅在难治性疾病的情况下才进行手术干预，且手术并不能治愈该病。目前，有五种主要的手术选择：淋巴管成形术、埋藏真皮瓣、淋巴静脉分流术、查尔斯手术以及皮瓣下分期皮下切除术。淋巴管成形术通常限于预期寿命有限的患者，因为其有益效果是短暂的。最常用的手术——埋藏真皮瓣、查尔斯手术以及皮瓣下皮下切除术——主要通过切除淋巴水肿的皮下组织来改善患者症状。对于目前正在研究的肠肠系膜桥接术和微淋巴管手术的疗效及未来适用性，仍存在诸多争议。需要进行长期随访。令人沮丧的事实仍然是，没有一种手术能治愈淋巴水肿；然而，我们认为，目前皮瓣下皮下切除术是手术治疗淋巴水肿症状最可靠且始终有益的方法。
