妇科恶性肿瘤术后下肢淋巴水肿的研究进展

Study of Lower Extremity Lymphedema after Surgery for Gynecological Malignant Tumor

摘要: 妇科恶性肿瘤治疗原则以手术治疗为主，术后根据指征给予相应的辅助治疗，盆腔淋巴结切除术是妇科恶性肿瘤手术治疗、病理分期、术后辅助治疗指导及预后结局判断的重要组成部分，然而这种损害淋巴系统的手术会导致下肢淋巴水肿(lymphedema of the lower extremity, LLE)，随着妇科癌症发病率和生存率的增加，应优先考虑对慢性并发症LLE的处理。LLE的自然病程包括腿围增加、纤维化、炎症、异常脂肪沉积和最终明显的皮肤病理，严重影响患者的生活质量。临床诊断依赖于病史，肿胀、麻木等临床表现和体格检查及各项辅助检查，患侧与未患侧的等效区域的比较反映了疾病的严重程度。治疗方式包括以复杂的降充血治疗为主的保守物理策略，以及新兴的显微外科治疗、外科干预，以及晚期疾病的吸脂术和还原切除手术。本文就妇科恶性肿瘤术后LLE的发生、危险因素、诊断和治疗现状进行以下综述。

Abstract: The treatment principle of gynecological malignant tumors is mainly surgical treatment, and postoperative adjuvant treatment is given according to the indications. Pelvic lymph node resection is an important part of surgical treatment, pathological staging, postoperative adjuvant treatment guidance and prognosis and outcome judgment of gynecological malignant tumors. However, such surgery that damages the lymphatic system may lead to lymphedema of the lower extremity (LLE). With the increase of the incidence and survival rate of gynecological cancer, the management of chronic complication LLE should be given priority. The natural course of disease includes increased limb circumference, fibrosis, inflammation, abnormal fat deposition and finally obvious skin pathology, which seriously affects the quality of life of patients. The clinical diagnosis depends on the history, the clinical manifestations such as swelling and numbness, and the physical examination and various auxiliary examinations. The comparison of the equivalent area between the affected and non-affected sides reflects the severity of the disease. Treatment options include conservative physical strategies characterized by complex decongestant therapy and intermittent pneumatic compression, as well as emerging microsurgical treatments, surgical interventions, and liposuction and reductive resection for advanced disease. This article reviews the occurrence, risk factors, diagnosis and treatment status of postoperative LLE for gynecological malignant tumors.