Microsurgical techniques for lymphedema treatment: Derivative lymphatic-venous microsurgery
Microsurgical techniques for lymphedema treatment: Derivative lymphatic-venous microsurgery
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DOI：
10.1007/s00268-004-7252-4
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发表时间：
2004-06-01
影响因子：
2.6
通讯作者：
Boccardo, F
中科院分区：
文献类型：
--
作者：
Campisi, C;Boccardo, F
我们分析慢性周围性水肿的临床病理和影像学特征，以确定其确切的发病机制，并建立最佳的治疗策略的影像学表现。显微外科治疗水肿的主要问题之一是出色的技术可能性与随后的水肿组织纤维化和硬化减少不足之间的差异。基于病理学研究和手术结果的适当治疗尚未得到充分记录。在过去的25年中，676例外周水肿患者接受了显微外科手术治疗。在这些患者中，447例（66%）可用于长期随访研究。通过水容量法和淋巴管造影进行客观评估。客观地，561例患者（83%）的容量变化显示出显著改善，平均减少了67%的多余容量。在随访的447例患者中，380例（85%）能够停止使用保守措施，平均随访时间超过7年，多余体积平均减少69%。显微手术后蜂窝织炎的发生率降低了87%。显微外科血管-静脉栓塞术在治疗周围性水肿中占有一席之地，对于非手术治疗效果不佳的患者应作为首选治疗。在水肿的第一阶段，早期进行手术可以改善结果。
We analyzed clinicopathologic and imaging features of chronic peripheral lymphedema to identify imaging findings indicative of its exact etiopathogenesis and to establish the optimal treatment strategy. One of the main problems of microsurgery for lymphedema is the discrepancy between the excellent technical possibilities and the subsequently insufficient reduction of the lymphedematous tissue fibrosis and sclerosis. Appropriate treatment based on pathologic studies and surgical outcome have not been adequately documented. Over the past 25 years, 676 patients with peripheral lymphedema have been treated with microsurgical lymphatic-venous anastomoses. Of these patients, 447 (66%) were available for long-term follow-up study. Objective assessment was undertaken by water volumetry and lymphoscintigraphy. Objectively, volume changes showed a significant improvement in 561 patients (83%), with an average reduction of 67% of the excess volume. Of the 447 patients followed, 380 (85%) have been able to discontinue the use of conservative measures, with an average follow-up of more than 7 years and average reduction in excess volume of 69%. There was an 87% reduction in the incidence of cellulitis after microsurgery. Microsurgical lymphatic-venous anastomoses have a place in the treatment of peripheral lymphedema and should be the therapy of choice in patients who are not sufficiently responsive to nonsurgical treatment. Improved results can be expected with operations performed early, during the first stages of lymphedema.