Miller T A, Wyatt L E, Rudkin G H
Plastic Surgery Section at the West Los Angeles VA Medical Center, UCLA School of Medicine, USA.
Plast Reconstr Surg. 1998 Oct;102(5):1486-98; discussion 1499-501. doi: 10.1097/00006534-199810000-00022.
Numerous surgical procedures have been proposed for the management of lymphedema. The postoperative results vary, and unfortunately none of the procedures are curative. As a result, some degree of recurrence of leg edema is seen in all patients postoperatively. Reported here is a long-term follow-up of patients with lower extremity lymphedema managed by skin and subcutaneous tissue excision. Thirty-eight patients (6 male; 32 female) with lower extremity lymphedema have been followed up for an average of 14 (3 to 27) years after staged subcutaneous excisions performed beneath skin flaps. Seven patients had been treated previously by other procedures. Of the 38 lymphedema patients, 10 patients developed edema after pelvic or groin ablative surgery, radiation therapy, or both. Results were documented by various methods: physical examination, circumferential measurements, volume displacement, serial photography, lymphoscintigraphy, and patient survey. Of these, it is believed that photographs are the easiest and as representative as any other method, all of which have great variability. Of the 38 patients, 30 patients had significant and long-lasting reduction in extremity size associated with improved function and extremity contour. Episodes of recurrent cellulitis were reduced or completely eliminated. No differences in the long-term results were seen in patients with acquired as opposed to congenital lymphedema. Men did not have as much improvement as women. Two patients had no change in leg swelling, and six patients (three men) had progressive swelling after surgery. Partial wound separation occurred immediately postoperatively in one patient, and three patients had loss (less than 2 cm) of the skin flap, all in the ankle region. None of these instances required further surgery, and no other significant complications were encountered. Staged skin and subcutaneous excision beneath skin flaps appears to provide long-lasting improvement for lower extremity lymphedema, regardless of cause, in the majority of patients treated.
针对淋巴水肿的治疗，人们提出了许多外科手术方法。术后效果各不相同，遗憾的是，没有一种手术能治愈该病。因此，所有患者术后都会出现一定程度的腿部水肿复发。本文报告了采用皮肤及皮下组织切除术治疗下肢淋巴水肿患者的长期随访结果。38例下肢淋巴水肿患者（6例男性，32例女性）在皮瓣下分期进行皮下切除术后，平均随访了14年（3至27年）。其中7例患者此前曾接受过其他治疗。在这38例淋巴水肿患者中，10例在盆腔或腹股沟切除手术、放射治疗或两者兼施后出现了水肿。通过多种方法记录结果：体格检查、周径测量、容积置换、系列摄影、淋巴闪烁显像及患者调查。其中，人们认为摄影是最简便的方法，且与其他任何方法一样具有代表性，而所有这些方法的差异都很大。38例患者中，30例患者的肢体尺寸显著且持久缩小，功能及肢体外形得到改善。复发性蜂窝织炎发作次数减少或完全消除。后天性淋巴水肿患者与先天性淋巴水肿患者的长期结果未见差异。男性患者的改善程度不如女性患者。2例患者腿部肿胀无变化，6例患者（3例男性）术后出现进行性肿胀。1例患者术后立即出现部分伤口裂开，3例患者皮瓣坏死（小于2厘米），均发生在踝部区域。这些情况均无需进一步手术，也未出现其他严重并发症。对于大多数接受治疗的患者，无论病因如何，皮瓣下分期皮肤及皮下切除术似乎都能为下肢淋巴水肿带来持久改善。
