A Prospective Analysis of 100 Consecutive Lymphovenous Bypass Cases for Treatment of Extremity Lymphedema
A Prospective Analysis of 100 Consecutive Lymphovenous Bypass Cases for Treatment of Extremity Lymphedema
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DOI：
10.1097/prs.0b013e3182a4d626
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发表时间：
2013-11-01
影响因子：
3.6
通讯作者：
Skoracki, Roman
中科院分区：
文献类型：
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作者：
Chang, David W.;Suami, Hiroo;Skoracki, Roman
背景：作者前瞻性地评价了淋巴静脉转流术在癌症继发淋巴水肿患者中的疗效。方法：作者前瞻性地纳入了100例癌症继发肢体淋巴水肿患者。65例患者采用吲哚青绿荧光淋巴管造影术进行淋巴静脉搭桥术。评价方法包括术前、术后3、6、12个月的定性评估和定量容量分析。结果：89条上肢和11条小腿均行淋巴管转流术。对于上肢淋巴水肿者，术前平均体积差为32%。96%的患者报告症状改善，74%的患者注意到数量改善。术后3个月、6个月和12个月的总体平均体积差缩小分别为33%、36%和42%。在淋巴静脉旁路术后3、6和12个月，1期或2期淋巴水肿组的平均体积差缩小(分别为58%、52%和61%)明显大于3期或4期淋巴水肿组(分别为12%、16%和17%)。共对7例肢体淋巴水肿患者进行了11次搭桥手术，术前平均体积差为38%。这些患者中只有4例(57%)报告症状改善，其中只有2例有术后容量测量。结论：淋巴静脉转流术可以有效地降低淋巴水肿的严重程度，特别是在早期上肢淋巴水肿的患者。吲哚青绿淋巴管造影术准确识别功能性淋巴管，在客观评估淋巴水肿严重程度和患者选择方面可能有作用。临床问题/证据水平：治疗性，IV。
Background: The authors prospectively evaluated the efficacy of lymphovenous bypass in patients with lymphedema secondary to cancer treatment.Methods: The authors prospectively enrolled 100 consecutive patients with extremity lymphedema secondary to cancer treatment. Sixty-five patients underwent lymphovenous bypass with indocyanine green fluorescent lymphangiography. Evaluation included qualitative assessment and quantitative volumetric analysis before and 3, 6, and 12 months after bypass.Results: Lymphovenous bypass was performed in 89 upper extremities and 11 lower extremities. For upper extremity lymphedemas, the mean preoperative volume differential was 32 percent. Symptom improvement was reported by 96 percent of patients and quantitative improvement was noted by 74 percent. The overall mean volume differential reduction was 33 percent at 3 months, 36 percent at 6 months, and 42 percent at 12 months after surgery. The mean volume differential reductions at 3, 6, and 12 months after lymphovenous bypass in patients with stage 1 or 2 lymphedema (58, 52, and 61 percent, respectively) were significantly larger than those in the patients with stage 3 or 4 lymphedema (12, 16, and 17 percent, respectively). Eleven bypasses were performed in seven patients with lower extremity lymphedema, with a mean preoperative volume differential of 38 percent. Only four (57 percent) of these patients reported symptom improvement; postoperative volume measurements were available for only two of these four.Conclusions: Lymphovenous bypass can be effective in reducing lymphedema severity, particularly in patients with early-stage upper extremity lymphedema. Indocyanine green lymphangiography accurately identified functional lymphatic vessels and may have a role in objectively assessing lymphedema severity and patient selection.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.