Sanka Sai Anusha, Chryssofos Sophia, Anolik Rachel A, Sacks Justin M
Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Med Oncol. 2025 Jan 13;42(2):44. doi: 10.1007/s12032-024-02576-2.
Lymphedema is a chronic condition caused by the accumulation of protein-rich fluid in the interstitial tissue, resulting in edema and a diminished quality of life. When first-line treatments like complete decongestive therapy (CDT) fail, surgical options are considered. These include physiological procedures like lymphaticovenous anastomosis (LVA) and vascularized lymph node transfer (VLNT), which aim to restore lymphatic function, as well as reductive procedures such as liposuction and excisional techniques, which reduce limb volume. Previous studies have evaluated these surgeries, but the literature remains scattered. This rapid review consolidates current research on surgical treatments for lymphedema. We reviewed the PubMed database and included systematic reviews, meta-analyses, randomized clinical trials, and literature reviews published between 2014 and 2024. Studies were selected if they reported outcomes such as objective volume reduction, patient-reported quality of life (QOL), or infection rates. Nineteen publications were selected for review. The most common procedures represented were LVA (N = 12) and VLNT (N = 10), though reductive operations such as liposuction and radical excision were also represented. Both LVA and VLNT, either alone or combined, demonstrated positive outcomes in terms of volume reduction, QOL, and infection prevention. Reductive surgeries were effective in reducing long-term volume but had less favorable cosmetic outcomes and variable infection rates. Overall, while surgical approaches have proven beneficial, the variability in outcome measures and inconsistent follow-up periods limit comparability across studies. Further research is needed to better guide patients in selecting the most appropriate surgical option based on their lymphedema characteristics and personal goals.
淋巴水肿是一种慢性疾病，由富含蛋白质的液体在间质组织中积聚引起，导致水肿并降低生活质量。当完全减压疗法（CDT）等一线治疗失败时，会考虑手术选择。这些手术包括旨在恢复淋巴功能的生理性手术，如淋巴管静脉吻合术（LVA）和带血管蒂淋巴结转移术（VLNT），以及旨在减少肢体体积的减容性手术，如抽脂术和切除技术。先前的研究已经对这些手术进行了评估，但文献仍然分散。本快速综述整合了当前关于淋巴水肿手术治疗的研究。我们检索了PubMed数据库，纳入了2014年至2024年发表的系统评价、荟萃分析、随机临床试验和文献综述。如果研究报告了诸如客观体积减少、患者报告的生活质量（QOL）或感染率等结果，则将其纳入。共选择了19篇出版物进行综述。所代表的最常见手术是LVA（N = 12）和VLNT（N = 10），不过抽脂术和根治性切除术等减容性手术也有涉及。单独或联合使用时，LVA和VLNT在体积减少、生活质量和感染预防方面均显示出积极结果。减容性手术在减少长期体积方面有效，但美容效果较差，感染率也各不相同。总体而言，虽然手术方法已被证明有益，但结果测量的变异性和随访期的不一致限制了各研究之间的可比性。需要进一步研究，以更好地指导患者根据其淋巴水肿特征和个人目标选择最合适的手术方案。
