基于算法浅谈继发性下肢淋巴水肿的外科整合治疗

邓呈亮; 陈君哲; 肖顺娥; 吴祥奎; 李海; 吴必华; 魏在荣

doi:10.3760/cma.j.cn501225-20250217-00067

基于算法浅谈继发性下肢淋巴水肿的外科整合治疗

doi: 10.3760/cma.j.cn501225-20250217-00067

遵义医科大学附属医院烧伤整形外科，遵义 563003

基金项目:

国家自然科学基金面上项目 82372541

国家自然科学基金地区科学基金项目 82260391

国家自然科学基金地区科学基金项目 82360448

贵州省淋巴水肿基础与临床研究科技创新人才团队建设 2025-051

详细信息

通讯作者:
邓呈亮，Email：cheliadeng@sina.com

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出版历程
- 收稿日期: 2025-02-17

An overview of integrated surgical management for secondary lower limb lymphedema guided by algorithms

Department of Burn and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China

Funds:

General Program of National Natural Science Foundation of China 82372541

Regional Science Foundation Project of National Natural Science Foundation of China 82260391

Regional Science Foundation Project of National Natural Science Foundation of China 82360448

Talent Team Construction Project for Basic and Clinical Research on Lymphedema of Guizhou Province 2025-051

More Information

Corresponding author: Deng Chengliang, Email: cheliadeng@sina.com

摘要

摘要: 继发性淋巴水肿是一种因手术、外伤、感染等导致淋巴回流受阻，引起皮下组织发生炎症、水肿、脂肪沉积、纤维化等病变的慢性进展性疾病。早期、规范、整合、全程是继发性淋巴水肿的治疗原则，个性化规范治疗是其治疗目的。该文基于单中心的治疗经验，总结出继发性下肢淋巴水肿的外科整合治疗算法，提出个性化治疗需综合评估淋巴水肿的严重程度、病变成分及淋巴管功能，且需结合国际淋巴学会分期及影像学检查结果来进行。该算法基于分体区、分期及整合治疗原则，可实现精准的个性化干预，具备一定的临床推广价值。
- 淋巴水肿 /
- 算法 /
- 外科手术 /
- 整合治疗
Abstract: Secondary lymphedema is a chronic progressive disease caused by lymphatic flow obstruction due to surgery, trauma, infection, etc., leading to inflammation, edema, adipose deposition, and fibrosis in subcutaneous tissue. While early, standardized, integrated, and sustained treatment is the principle for managing secondary lower limb lymphedema, and the goal is to provide a personalized and standardized treatment. Based on single-center treatment experience, this article summarizes an integrated surgical treatment algorithm for secondary lower limb lymphedema. It proposes that personalized treatment requires comprehensive assessment of lymphedema severity, pathological components, and lymphatic function, incorporating the International Society of Lymphology staging and imaging findings. This algorithm is based on the principles of regionalization (body regions), staged approach, and integrated treatment to achieve precise personalized intervention, which demonstrates certain value for clinical promotion.
- Lymphedema /
- Algorithms /
- Surgical procedures, operative /
- Integrated treatment
本文亮点
(1) 首次提出针对下肢不同体区（大腿、小腿）继发性淋巴水肿的具体治疗推荐方案，以及根据国际淋巴学会分期和病变特点，采用分期或同期联合治疗的创新整合治疗算法，提升治疗效果并减轻患者负担。

(2) 系统梳理了继发性下肢淋巴水肿中“液态”与“固态”病变成分的区别，结合病变组织的具体成分，提出了针对性的生理性手术（如淋巴管-静脉吻合术、血管化淋巴结移植术）和减容手术（如脂肪抽吸术、保留穿支的减容手术等）整合方案，强调了个体化设计的重要性，避免单一治疗方式的局限。

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图 1 继发性下肢淋巴水肿的外科整合治疗算法示意图

注：ISL为国际淋巴学会

Figure 1. Schematic diagram of the integrated surgical treatment algorithm for secondary lower limb lymphedema

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