Physiologic surgical interventions, including lymphovenous bypass (LVB) and vascularized lymph node transplant (VLNT), are increasingly being used to treat lymphedema. LVB has been shown to be effective in improving the severity of lymphedema, particularly for patients with still-functional superficial lymphatic vessels that can be identified for bypass. However, in many patients, there is a paucity of functional lymphatic vessels for bypass and, thus, they are not ideal candidates for LVB alone. Unlike LVB, VLNT does not depend on the presence of functioning lymphatic vessels, but the effects of VLNT are delayed, as the proposed mechanisms of action require more time for optimal function. The author has offered a combined approach to microsurgical treatment of lymphedema for both the upper and lower extremities. Simultaneous VLNT and LVB are safe and effective for patients with both early and advanced stages of primary and secondary lymphedema. Our experience shows that a majority of patients can expect some long-term improvement, in both overall limb volume and quality of life, after surgical intervention with LVB and/or VLNT.

中文翻译：

---

手术治疗淋巴水肿的综合方法

生理手术干预，包括淋巴静脉搭桥 (LVB) 和血管化淋巴结移植 (VLNT)，越来越多地用于治疗淋巴水肿。LVB 已被证明可有效改善淋巴水肿的严重程度，特别是对于表面淋巴管功能尚可且可识别为旁路的患者。然而，在许多患者中，缺乏用于旁路的功能性淋巴管，因此，它们不是单独进行 LVB 的理想人选。与 LVB 不同，VLNT 不依赖于功能性淋巴管的存在，但 VLNT 的作用被延迟，因为所提出的作用机制需要更多时间才能达到最佳功能。作者提供了一种显微外科治疗上肢和下肢淋巴水肿的联合方法。同时进行 VLNT 和 LVB 对原发性和继发性淋巴水肿的早期和晚期患者都是安全有效的。我们的经验表明，在使用 LVB 和/或 VLNT 进行手术干预后，大多数患者可以预期在整体肢体体积和生活质量方面有一些长期改善。