Surgical management of genital lymphoedema:experience and critical considerations from a tricenter study  

作　　者：Martino Guiotto Michele Maruccia Rossella Elia Marco Fresa Lidia Molinari Marie Nicod Lalonde Corrado Campisi Pietro Giovanni di Summa 

机构地区：[1]Department of Plastic and Hand Surgery,Centre Hospitalier Universitaire Vaudois(CHUV),Lausanne 1011,Switzerland [2]Department of Plastic Surgery,Bari University Hospital,Bari 70124,Italy [3]Angiology Department,Centre Hospitalier Universitaire Vaudois(CHUV),Lausanne 1011,Switzerland [4]Department of Plastic Surgery,Lymphatic Unit,San Martino Hospital,Genova 16132,Italy [5]Nuclear Medicine and Molecular Imaging,Centre Hospitalier Universitaire Vaudois(CHUV),Lausanne 1011,Switzerland

出　　处：《Plastic and Aesthetic Research》2023年第1期629-642,共14页整形与美容研究（英文版）

摘　　要：Aim:Genital lymphoedema(GL)is a chronic and debilitating disease,which can severely affect the patient’s quality of life with significant socio-economic impact.Nowadays,no gold standard algorithm exists for GL from diagnosis to treatment.This study proposes our therapeutic flowchart based on the three senior consultants’experience in lymphatic surgery.Methods:A retrospective investigation was conducted on a prospectively maintained database(2018-2022).Inclusion criteria involved all patients who underwent surgical procedures for treating GL in three plastic surgery departments(Lausanne,Bari,and Genova).Outcomes were assessed in terms of oedema reduction,stage regression,and functional reported outcomes.Results:16 patients with GL were included:50%underwent debulking surgery,18.8%microsurgery,and 31.2%debulking+microsurgery.We recorded a significant regression of the GL stage:62.5%shifted from stage II/III to postoperative stage I.Similarly,we found an infection recurrency resolution in 50%,a scrotal oedema reduction in 62.5%,and a scrotal oedema resolution in 37.5%of the patients treated.While almost half of the patients(53.3%)with associated penile oedema described persistent postoperative penile oedema,only two patients complained of persistent lymphorrhea.Conclusion:According to our clinical experience,preoperative and postoperative physical functional therapy is always recommended.For stages I and IIA,after the failure of the conservative treatment,lymph-venous shunts and lymph node transplantation surgery are proposed at the early time.When GL is already diagnosed at stages IIB and III,the debulking surgery,together with functional procedures,represents our first approach.

关 键 词：Genital lymphoedema debulking surgery functional surgery MICROSURGERY lymphatic venous anastomosis multi lymphatic-venous anastomoses lymph node transplantation 

分 类 号：R73[医药卫生—肿瘤]