薄层血管化腹股沟淋巴结皮瓣移植联合反向淋巴显影在继发性上肢淋巴水肿手术中的应用

目的 探讨薄层血管化腹股沟淋巴结皮瓣移植联合反向淋巴显影在继发性上肢淋巴水肿手术中的应用效果.方法 2019年7月至2020年9月,应用吲哚菁绿、美蓝双染法引导的反向淋巴显影术,制备薄层游离血管化腹股沟淋巴结皮瓣,切取后移植于患侧上肢,治疗乳腺癌术后继发性淋巴水肿患者5例.皮瓣约10 cm×5 cm大小,平均厚度约0....     

携带淋巴结的组织瓣移植治疗下肢淋巴水肿

目的 探讨携带淋巴结的组织瓣移植治疗下肢淋巴水肿的疗效.方法 2019年6月至2021年6月,采用携带淋巴结的组织瓣移植治疗Ⅱ～Ⅲ期下肢淋巴水肿5例,皮瓣大小(10～30)cm×(4～9)cm,受区选择患肢小腿区,受区血管为胫前动脉及伴行静脉,术后定期随访.结果 1例皮瓣术后部分坏死,予以换药对症治疗后,创面瘢痕愈合,...     

血管化淋巴结皮瓣移植治疗下肢淋巴水肿的研究进展

下肢淋巴水肿的治疗是临床研究中的难点和重点.严重的下肢淋巴水肿对患者的生存质量影响极大.近年来,血管化淋巴结皮瓣移植作为一种新兴的手术方式,对重度下肢淋巴水肿具有较好的治疗效果.本文对血管化淋巴结皮瓣移植的作用机制、手术方式、辅助手段、常见并发症等方面的研究进展进行综述.     

带血运淋巴结移植治疗肢体淋巴水肿的研究进展

目的综述带血运淋巴结移植治疗肢体淋巴水肿的动物及临床研究进展。方法广泛查阅近年来国内外有关带血运淋巴结移植治疗肢体淋巴水肿的相关研究文献,进行分析总结。结果动物实验提示,与无血管吻合的淋巴结移植相比,带血运淋巴结移植可提高淋巴结成活率,有效减轻肢体淋巴水肿。虹吸假说和淋巴结泵假说是淋巴结移植治疗淋巴水肿两种主要可能机制,但目前均缺少确切的证据证实。临床研究提示,带血运淋巴结移植可显著降低患肢水肿程度,但研究随访时间较短,因远期存在淋巴水肿复发风险,所以该术式疗效有待长期、大规模临床研究进一步验证。结论带血运淋巴结移植可以有效缓解淋巴水肿症状,但其有效性及机制仍需要进一步研究。     

超声抽吸法治疗下肢原发性淋巴水肿

目的观察超声抽吸法治疗下肢原发性淋巴水肿的疗效。方法为12例患者采用内超声脂肪抽吸机吸除淋巴水肿组织以降低患肢淋巴负荷，抽吸后结合持续弹力袜裤压扎。结果术后2周水肿即时消退明显，术后1年随访水肿消退，复发不明显。结论超声抽吸法治疗原发性淋巴水肿安全简便，结合弹性袜裤压扎可望取得较好的远期疗效。     

淋巴结复合皮瓣治疗实验性肢体淋巴水肿的研究

目的 设计淋巴结复合皮瓣治疗实验性肢体淋巴水肿。方法 用１４只已形成右前肢淋巴水肿的大白兔,分别用吻合血管的淋巴结复合游离皮瓣移植和普通游离皮瓣移植法治疗。结果 淋巴结复合皮瓣移植组肢体淋巴水肿减轻,未见诱发供肢淋巴水肿。普通皮瓣移植组消肿作用不明显。结论 淋巴结复合皮瓣可以作为治疗肢体淋巴水肿的一种方法。     

下肢继发性淋巴水肿患者脂肪抽吸术中失血的处理

目的分析下肢继发性淋巴水肿患者脂肪抽吸术的失血量情况, 总结相关经验及处理策略。方法回顾性分析2018年9月至2020年1月共214例单侧下肢继发性淋巴水肿行脂肪抽吸术治疗患者的临床资料。结果患者中女209例, 男5例, 平均抽脂量(2 934.58±1 114.83 ml), 平均失血量(986.04±425.16)ml, 输血患者117例, 其中输注自体血90例, 输注异体血15例, 输注自体血+异体血12例, 患者淋巴水肿的分期、手术时间、抽脂量与失血量呈正相关, 是影响术中失血量的独立危险因素。结论下肢继发性淋巴水肿患者脂肪抽吸术的抽脂量较大、失血量较多, 是导致术后贫血的重要因素。     

肢体淋巴水肿的外科治疗及研究进展

肢体淋巴水肿是一种常见病和多发病，其治疗方法可分为保守治疗和外科治疗两大类，目的均是改善淋巴液生成与回流之间的平衡，促进或恢复淋巴回流，减小周径。随着对淋巴水肿发病机理的不断阐明，外科治疗方案也在不断改变，现对其外科治疗方法及研究进展做一回顾与探讨。１病变组织切除１．１负压抽吸法负压抽吸法是一种比较新的治疗肢体淋巴水肿的方法，20世纪80年代后期始用于临床。Brorson等[1～4]对该方法进行了系列报道，认为抽吸法与压迫疗法相结合治疗乳癌术后淋巴水肿非常有效，患肢水肿在术后3个月、12个月分别减少87%和97%，患…     

负压抽吸治疗肢体淋巴水肿

目的:研究负压抽吸治疗肢体淋巴水肿的治疗效果、预后及防止复发的措施。方法:利用脂肪负压吸引器,负压控制在0.08～0.1MPa,抽吸治疗28例患者共42例侧肢体淋巴水肿。抽吸方向尽量和肢体的纵轴平行,避免较多地损伤肢体浅部的皮神经和血管。结果:42例侧肢体淋巴水肿术后疗效较佳,上臂中段周径平均减少7cm,上举功能改善;小腿中段周径平均减少9～12cm,大腿中段周径平均减少10～14cm。随访2年效果基本稳定,在此期间,未见复发征象。结论:负压抽吸治疗肢体淋巴水肿有较好的疗效,为淋巴水肿的临床治疗提供了一种新的方法。     

MR淋巴造影术诊断肢体淋巴水肿

目的 探讨新的能够反映形态学和功能改变的淋巴循环系统疾病的影像诊断方法.方法 皮内注射钆贝葡胺注射液后采用Philip 3.0T MR成像仪进行扫描,观察淋巴结和淋巴管的形态改变和功能状况,包括淋巴液在管内的流速和腹股沟淋巴结内造影剂充盈的动态性改变.结果 30例门诊肢体淋巴水肿患者接受了检查,原发性下肢淋巴水肿27例,继发性淋巴水肿3例.注射造影剂后所有的患肢淋巴管均显影,原发性淋巴水肿肢体的淋巴管形态变异较大.测得的淋巴的流速为0.30～1.48 cm/min.患侧腹股沟淋巴结造影剂浓度显著低于健侧.造影剂在患侧淋巴结内达到峰值的时间和排除的时间均明显较健侧延迟.此外,患侧淋巴结内有造影剂部分充盈和髓质区先充盈等异常发现.结论 采用钆贝葡胺造影剂的MR淋巴造影是形态和功能兼备的肢体淋巴循环障碍疾病的检查方法.     

Vascularized appendicular lymph node transfer for treatment of extremity lymphedema: A case report

Vascularized lymph node transfer has demonstrated promising results for the treatment of extremity lymphedema. In an attempt to find the ideal donor site, several vascularized lymph nodes have been described. Each has a common goal of decreasing morbidity and avoiding iatrogenic lymphedema while obtaining good clinical results. Herein, we present the preliminary clinical outcomes of an intra‐abdominal lymph node flap option based on the appendicular artery and vein used for the treatment of extremity lymphedema. A 62 year‐old woman with moderate lower extremity lymphedema, on chronic antibiotics because of recurrent infections and unsatisfactory outcomes after conservative treatment underwent a vascularized appendicular lymph node (VALN) transfer. At a follow‐up of 6 months, the reduction rate of the limb circumference was 17.4%, 15.1%, 12.0% and 9% above the knee, below the knee, above the ankle and foot respectively. In addition, no further episodes of infection or other complications were reported after VALN transfer. Postoperative lymphoscintigraphy demonstrated that the VALN flap was able to improve the lymphatic drainage of the affected limb. According to our findings, the use of VALN transfer minimizes donor‐site morbidity, avoids iatrogenic lymphedema and may provide a strong clearance of infection because of the strong immunologic properties of the appendiceal lymphatic tissue in selected patients. Despite these promising results, further research with larger number of patients and longer follow‐ up is needed.     

Treatment of upper limb lymphedema with combination of liposuction, myocutaneous flap transfer, and lymph-fascia grafting: a preliminary study

Treatment of obstructive extremity lymphedema remains a challenge in reconstructive surgery, since none of the varieties of procedures have been demonstrated a reliable resolution for the lymphedema. In this report, we present the preliminary results of treatment of severe upper extremity lymphedema with combined liposuction, latissimus myocutaneous flap transfer, and lymph-fascia grafting in 11 patients. All patients had histories of radical mastectomy, irradiation therapy for breast cancer, and frequent onsets of erysipelas. Postoperative measurements in an average of 26 months follow up showed that significant decrease of circumferences of the arms on all levels at surgery side were achieved. The onsets of erysipelas were also reduced. There was no chronic lymphedema found in the donor leg after harvest of the lymph-fascia graft. The results suggest the strategy of liposuction, latissimus myocutaneous flap transfer, and lymph-fascia grafting may provide a useful method for treatment of the chronic upper extremity lymphedema with severe axillary scar contracture.     

Treatment of secondary scrotal and lower extremity lymphedema using combined pedicled lymph node transfer and lymphaticovenous anastomosis: A case report

Combined secondary scrotal and lower extremity lymphedema is an infrequent complication of radical excision of urogenital cancers associated with pelvic lymphadenectomy. Scrotal lymphedema is usually psychologically distressing, and difficult to treat. We report a case of a 41-years old male who presented with scrotal and left lower extremity lymphedema after radical prostatectomy and pelvic lymphadenectomy successfully treated with pedicled superficial inguinal lymph node (SILN) transfer and lymphaticovenous anastomosis (LVA) restoring the lymphatic drainage. The flap consisted of subscarpal adipofascial tissue between the level of the inguinal ligament and the groin crease measuring 11 × 7 cm. The flap composed of afferent lymphatics from the lower abdomen, lymph nodes, and fatty tissue without skin, the right-sided flap was transposed to the root of scrotum while the left one to the proximal left thigh, then two-level LVA were performed in the left extremity. The surgery went uneventful with no postoperative complications. At a 9 month follow-up, there was a significant reduction of the scrotal volume with a reduction of excess volume of the lower extremity from 49.6 to 9.4% compared with the healthy side. No cellulitis was reported during the follow-up period with improvement in the patient's clinical symptoms and quality of life. We believe that pedicled superficial inguinal lymph node flap together with LVA is a reliable and safe treatment option for either scrotal or lower extremity lymphedema following pelvic cancer treatment.     

复方中药组方淋巴方治疗肢体慢性淋巴水肿的疗效研究

目的 观察口服复方中药组方淋巴方治疗肢体慢性淋巴水肿的临床疗效。方法 2011年9月至2014年12月,239例肢体慢性淋巴水肿患者服用复方中药组方淋巴方,治疗前、后采用多频生物电阻人体成分分析仪,检测组织水肿程度,卷尺测量患肢周径变化。结果 患者服用复方中药淋巴方治疗1个疗程后(1个月),患肢组织水肿明显减轻(P<0.05),患肢周径明显缩小(P<0.05)。长期随访显示,患者主观感觉改善明显,丹毒发作频率明显减少。治疗前、后水分与周径变化具有明显相关性(r=0.738,P<0.01)。结论 复方中药淋巴方可有效减轻慢性淋巴水肿患者的肢体水肿。     

Erysipelas of the upper extremity following locoregional therapy for breast cancer

Cellulitis is a well-known complication of lymphedema of the lower extremities. Erysipelas of the upper extremity complicating breast cancer therapy has never been reported in the English-language literature. We describe seven breast cancer patients with erysipelas of the upper extremity. Five had a predisposing injury to the extremity. All patients responded very well to intravenous antibiotics without any sequelae. They had rapid resolution with typical desquamation. No long-term sequelae were seen except for mild increase of lymphedema. Erysipelas should be listed as a rare complication after locoregional therapy for breast cancer. Intravenous penicillin should be used as the initial therapy. Prevention of arm lymphedema and avoidance of any trauma to the arm are important prophylactic measures. Sentinel lymph node biopsy reduces the rate of axillary lymph node dissection and thus should reduce the incidence of lymphedema and erysipelas.     

Microsurgical lymphovenous anastomosis for treatment of lymphedema: a critical review

Lymphovenous anastomoses (LVA) offer ideal physiologic treatment for lymphedema, and our experimental data support late patency. Between Jan. 1, 1982, and April 1, 1986, 18 patients underwent operation for chronic lymphedema; LVA could be performed in 14 patients (10 women and four men). Six patients had secondary lymphedema of the upper extremity. One of eight patients with lymphedema of the lower extremity had filariasis, and seven had primary lymphedema. Mean follow-up was 36.6 months (range: 5 to 57 months). Limb circumference and volume, number of postoperative episodes of cellulitis, and lymphoscintigraphy were used to assess results. Improvement occurred in three upper extremities and two lower extremities. There was no change in five extremities, and in four patients the edema progressed. One patient with primary lymphedema and four of seven patients with secondary lymphedema improved. Only one of five patients benefited from one anastomosis; however, all patients with more than two anastomoses improved. Lymphoscintigraphy was performed in 10 patients. No lymphatic channel was visualized before operation in three patients, and at operation none was found. In four other patients lymph channels localized by lymphoscintigraphy were identified during operation. Significant improvement was documented by lymphoscintigraphy in one patient after operation, and this patient had permanent improvement 30 months later. Patients with primary lymphedema had disappointing results, but four of seven patients with secondary lymphedema benefited from LVA, especially if several anastomoses could be performed. Lymphoscintigraphy appears to be a suitable method of both identifying patent lymph channels before surgery and determining function of LVA after operation. However, presently objective data to prove the clinical efficacy of this operation are lacking.     

Re-evaluation of qualitative lymphangioscintigraphic findings in secondary lower extremity lymphedema

Purpose

To re-evaluate whether qualitative lymphangioscintigraphy (LAS) findings are sensitive enough to diagnose or classify the clinical severity of lower extremity lymphedema.

Methods

LAS was performed in 78 extremities with lymphedema and 24 extremities without lymphedema between April, 2009 and March, 2012. We assessed the proportion of extremities in which there was no visual evidence of the ilioinguinal lymph nodes (LN-60) or the lymphatic trunk (Tr-60) 60 min after tracer injection, the number of visualized ilioinguinal lymph nodes (#LN), and the proportion of extremities with dermal backflow (pDBF) and lymph stasis (pLS). These were associated with the International Society of Lymphology (ISL) clinical stage.

Results

LN-60, Tr-60, #LN, pDBF, and pLS, especially when extending into both the thigh and lower leg, were significantly associated with the ISL stage. The sensitivity of LN-60, Tr-60, and #LN <2 for diagnosing lymphedema was 49, 47, and 59 %, respectively, with no significant difference among these parameters for consecutive ISL stages.

Conclusions

None of the above measures was sufficiently sensitive to diagnose lymphedema or classify the severity of the disease; however, each of these criteria can aid in diagnosis, by excluding other diseases and assessing disease pathophysiology.     

Chimeric thoracodorsal lymph node flap with a perforator-based fasciocutaneous skin island for treatment of lower extremity lymphedema: A case report

Free vascularized lymph node transfer (VLNT) is applied more and more in the treatment of lymphedema. A random-pattern skin island with VLNT is of use but can have its limitations in flap inset. We describe an option for free VLNT in the treatment of lower extremity lymphedema. We present the case of a chimeric thoracodorsal lymph node flap (TAP-VLNT) with a thoracodorsal artery perforator (TAP) flap (5 × 9 cm) to the lower leg in a 22-year old female patient with stage 2 lower leg lymphedema caused by severe traumatic skin decollement and postoperative scarring after a car accident. TAP flap enabled tailored and tension-free wound closure at the recipient site after scar release and lymph node flap inset. The anastomosis was performed to the anterior tibial artery. The postoperative course was uneventful with no complications or secondary donor-site lymphedema. Follow-up at 6 months showed reasonable cosmetic and functional outcomes. The circumference reduction rate was up to 11% and the patient reported improved quality of life. The purpose of this report is to describe a case of a more flexible lymph node flap inset and tension-free wound closure by harvesting a thin thoracodorsal artery perforator (TAP) skin island together with a thoracodorsal VLNT as a chimeric flap (TAP-VLNT) for treatment of lower extremity lymphedema. Larger series with longer follow-up data are needed to justify its widespread use and demonstrate long-term results.