Lower extremity lymphedema index: a simple method for severity evaluation of lower extremity lymphedema

Measurement of the circumference is the most commonly used method for evaluating extremity lymphedema. However, comparison between different patients is difficult with this measurement. To resolve this problem, we have formulated a new index, lower extremity lymphedema (LEL) index, which can be easily obtained from measurements of the body. We evaluated correlation between lower LEL index and clinical stage in patients with LEL. The LEL indices were significantly correlated with clinical stages and could be used as a severity scale. The LEL index makes objective assessment of the severity of lymphedema through a numerical rating, regardless of the body type. This numerical rating makes the index useful for evaluation of lymphedema severities between different cases.     

间质磁共振淋巴造影技术在下肢淋巴水肿中的临床应用

目的 评价皮内注射顺磁性造影剂钆贝葡胺进行间质磁共振淋巴造影的可行性.方法 下肢淋巴水肿进展期患者10例共12侧患肢.在双足第1～4趾蹊背面皮内各注射钆贝葡胺1ml,共8 ml,选择三维容积内插快速绕相梯度回波,并行最大密度投影重建显示淋巴管和淋巴结.结果 10例12侧患肢中有11侧小腿段显示串珠状淋巴管,最佳强化时间在造影后15～30 min,大腿段显示6侧,最佳强化时间在造影后45 min.结论 间质磁共振淋巴造影是一种安全有效可行的显示淋巴水肿下肢淋巴管的新方法.     

Ultrasonic examination in secondary lymphedema of the lower extremities

The article deals with the results of ultrasonic examination (USE) of 39 patients with secondary edema of the lower extremities. The authors developed a USE method which yields objective data characterizing changes of the structure, thickness, boundaries, and firmness of the soft tissues in lymphedema of the lower extremities of various severity. It was established that lymphostasis produced a characteristic ultrasonic pattern, which, as claimed by the author, may be used in differential diagnosis of lymphatic and venous edema of the extremities.     

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,其余4例移植皮瓣顺利成活。术后随访0.5～2年,患肢周径于术后1个月及6个月平均减少0.84 cm及2.29 cm,术后未出现淋巴管炎,供区未出现淋巴漏及淋巴水肿。结论 应用淋巴结皮瓣移植治疗肢体淋巴水肿近期疗效较好,供区无并发症,是早中期下肢淋巴水肿可选择的治疗方法之一。     

Performing lympho-venous anastomoses at several levels of the lower extremity in primary lymphedema

Operations were conducted on 41 patients, 31 of them had a primary form of lymphedema. Lymphovenous anastomoses (LVA) were formed in the region of the medial collector on the thigh in Scarpa's triangle, in the middle third of the leg, and on the dorsum of the foot. The results were good in the late-term postoperative period in 74.0% of patients. According to earlier studies, the formation of LVA in patients with primary lymphedema of the lower limbs only on one of the standard levels produces good late-term postoperative results in 57.8% of cases.     

下肢慢性淋巴水肿的MRI表现与淋巴闪烁造影的比较

目的　探讨下肢慢性淋巴水肿的ＭＲＩ表现和诊断价值。方法　对１２ 例慢性淋巴水肿下肢作ＭＲＩ检查,并与淋巴闪烁显像（Ｌｙｍｐｈａｎｇｉｏｓｃｉｎｔｉｇｒａｐｈｙ ＬＡＳ） 相比较。结果　ＭＲＩ图像的特征是皮下组织层明显增厚伴广泛水肿;真皮下扩张的淋巴管以及淋巴液潴留在组织间形成“裂隙”使皮下组织层呈典型的网络状或蜂窝状结构。结论　ＭＲＩ清晰地显示增生扩张的集合淋巴管和淋巴干及乳糜池,以及组织中乳糜返流的程度和范围。ＬＡＳ图像的特征包括显影剂在组织中弥散、积聚（ 真皮返流）或滞留在注射点;淋巴管显影不充分或不显影;淋巴结延迟显影或不显影及数目和形态的变化。ＭＲＩ较全面地显示各级淋巴管、淋巴结以及周围软组织的形态变化。ＬＡＳ有助于判断淋巴系统的功能状况。两种检查联合使用,能更全面反映周围淋巴系统的形态解剖及功能的变化,提高肢体慢性淋巴水肿的诊断     

下肢慢性淋巴水肿的MRI表现与淋巴闪烁造影的比较

目的探讨下肢慢性淋巴水肿的 MRI 表现和诊断价值。方法对12例慢性淋巴水肿下肢作 MRI 检查,并与淋巴闪烁显像(Lymphangioscintigraphy LAS)相比较。结果 MRI 图像的特征是皮下组织层明显增厚伴广泛水肿;真皮下扩张的淋巴管以及淋巴液潴留在组织间形成“裂隙”使皮下组织层呈典型的网络状或蜂窝状结构。结论 MRI 清晰地显示增生扩张的集合淋巴管和淋巴干及乳糜池,以及组织中乳糜返流的程度和范围。LAS 图像的特征包括显影剂在组织中弥散、积聚(真皮返流)或滞留在注射点;淋巴管显影不充分或不显影;淋巴结延迟显影或不显影及数目和形态的变化。MRI 较全面地显示各级淋巴管、淋巴结以及周围软组织的形态变化。LAS 有助于判断淋巴系统的功能状况。两种检查联合使用,能更全面反映周围淋巴系统的形态解剖及功能的变化,提高肢体慢性淋巴水肿的诊断。     

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。     

下肢慢性淋巴水肿的MRI表现与淋巴闪烁造影的比较

目的 探讨下肢慢性淋巴水肿的ＭＲＩ表现和诊断价值。方法 对１２例慢性淋巴水肿下肢作ＭＲＩ检查,并与淋巴闪烁显像（Ｌｙｍｐｈａｎｇｉｏｓｃｉｎｍｔｉｇｒａｐｈｙ ＬＡＳ）相比较。结果 ＭＲＩ图像的特征是皮下组织层明显增厚伴广泛水肿;真皮下扩张的淋巴管以及淋巴液潴留在间形成“裂隙”使皮下组织层呈的网络状或蜂窝状结构。结论ＭＲＩ清晰地显示增生扩张的集合淋巴管和淋巴干及乳糜池,以及组织中乳糜返流的程度和范     

宫颈癌患者术后下肢淋巴水肿发生状况及危险因素分析

目的分析宫颈癌患者术后下肢淋巴水肿发生情况及相关危险因素。方法应用妇科癌症淋巴水肿问卷电话调查492例手术治疗的宫颈癌患者下肢淋巴水肿发生情况,并分析术后下肢淋巴水肿的危险因素。结果宫颈癌患者术后下肢淋巴水肿发生率为20.93%,严重程度以Ⅰ度为主(占86.41%),中位发生时间为5.5个月。logistic回归分析表明,年龄、淋巴结清扫数目、术后辅助放疗、持续站立时间是术后下肢淋巴水肿发生的危险因素,规律运动锻炼是其保护因素(P0.05,P0.01)。243例术后联合放疗患者下肢淋巴水肿发生的危险因素为淋巴结清扫数目20枚及术后放疗开始时间45d(P0.05,P0.01)。结论下肢淋巴水肿是宫颈癌术后常见的并发症,年龄大、淋巴结清扫数目多、辅助放疗、长时间站立的患者是下肢淋巴水肿发生的高危人群。医护人员应做好高危人群筛查,及时给予健康教育,并积极探寻有效的预防干预措施,降低术后下肢淋巴水肿的发生率。     

Supermicrosurgical lymphaticovenular anastomosis and lymphaticovenous implantation for treatment of unilateral lower extremity lymphedema

Recent supermicrosurgical techniques have developed the possibility for vascular anastomosis of smaller vessels and it is now safe and sound to perform precise anastomoses between lymphatics and venules. Reported here is the 2 years experience on supermicrosurgical lymphaticovenular anastomosis and/or lymphaticovenous implantation combined with a nonoperative physical therapy for treatment of lower extremity lymphedema. Microlymphatic surgery was performed in 42 patients with unilateral lower extremity lymphedema. Thirty patients were women and 12 were men with a mean age of 34. Lymphaticovenular anastomoses were performed in 37 patients with an average of 2.5 anastomoses per patient, and lymphaticovenous implantations were made in 36 patients with an average of 2.4 implantations per patient. The lymphatics that were larger than 0.3 mm were anastomosed to venules with supermicrosurgical technique. Lymphaticovenous implantation technique was used for thinner lymphatics in a particular incision. Postoperatively, 18 patients used continuous compressive garments, 9 patients used garments but discontinued after 6 months, and no compression was used in 9 patients. The results of surgery were assessed both clinically with volume measurements and by lymphoscintigraphy and were classified as good, moderate, or ineffective. The mean decrease in the volume of the edema was 59.3% at an average follow‐up of 11.8 months. Six outcomes were classified as ineffective, eight outcomes as moderate, and 28 outcomes as good. Supermicrosurgical lymphaticovenular anastomosis and/or lymphaticovenous implantation seems to be highly beneficial, especially in the early stages of peripheral lymphedema and may be offered as the treatment of choice in selected patients. © 2009 Wiley‐Liss, Inc. Microsurgery 2009.     

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.     

病变组织切除皮肤回植术治疗晚期下肢淋巴水肿

目的:研究和探索晚期下肢淋巴水肿手术治疗的有效方法.方法:采用病变组织切除皮肤回植方式治疗晚期下肢淋巴水肿. 结果:所有患者术后患肢外形较术前明显变细,功能恢复良好,5例患者中有4例首次植皮成活90%,外形功能恢复比较理想,1例首次植皮成活较差,再次植皮修复,功能恢复,但外观不理想.结论:对严重的晚期淋巴水肿患者,采用病变组织切除次全厚皮肤回植是较好的治疗方法.     

宫颈癌术后下肢淋巴水肿影响因素的病例对照研究

目的探讨宫颈癌术后下肢淋巴水肿的影响因素,为临床综合防治提供依据。方法采用病例对照研究设计,将253例宫颈癌手术后发生下肢淋巴水肿的患者作为病例组,采用1∶2配对将未发生下肢淋巴水肿的506例作为对照组。比较两组人口社会学、术前及术后生活行为特征,采用logistic回归分析确定下肢淋巴水肿的影响因素。结果 logistic回归分析显示,文化程度高、术前/术后长时间站立或坐立等身体保持同一姿势、术后上班、术后日常生活活动(以家务活或农活为主)是宫颈癌术后下肢淋巴水肿发生的危险因素;夫妇同住及夫妇+子女同住、术前日常劳动强度大、术前规律运动、术后运动频次高是保护因素(P<0.05,P<0.01)。结论宫颈癌患者术后下肢淋巴水肿的影响因素较多,应针对高危人群及时进行健康教育,积极采取预防性干预措施,以预防和减少术后下肢淋巴水肿的发生。     

Role of tensor fascia lata musculocutaneous flap in lymphedema of the lower extremity and external genitalia

The tensor fascia lata (TFL) musculocutaneous flap has been used to cover raw areas resulting after block dissection of fungating cancerous glands in the groin. Postoperative lymphorrhea, a frequent serious problem after groin block dissection, was not seen. It was inferred that the TFL musculocutaneous flap absorbed lymph. This observation was used in treating patients with lymphedema of the lower extremity and genitalia. Groin block dissection was performed in 12 patients with tubercular and filarial lymphedema. By performing a groin block dissection, lymph was allowed to escape in the area of dissection and the TFL musculocutaneous flap absorbed the lymph. As a result a consistent reduction in the size and edema of the affected areas was noted. Wrinkling and suppleness of skin was seen in each patient within the first week. In 1 patient with congenital lymphedema, edema was restricted to the leg and foot. In this patient, groin block dissection was not performed. One end of the TFL musculocutaneous flap was transferred to the calf, and in second stage the proximal end with the whole flap was transferred to the back of the thigh and popliteal fossa. The TFL musculocutaneous flap here acted as a bridge between the area of congenital lymphedema (leg) and the area with normal lymphatic drainage (thigh).     

六步综合消肿法在宫颈癌术后下肢淋巴水肿患者的应用

目的 探讨六步综合消肿疗法应用于宫颈癌术后下肢淋巴水肿患者的效果。方法 选取宫颈癌行广泛性子宫切除术后单侧下肢淋巴水肿患者,其中轻度水肿25例,中度68例,重度12例,均由获得国际淋巴水肿治疗师资格的专科护士给予包括皮肤护理、舒缓瘢痕组织、徒手淋巴引流、空气压力波水肿治疗仪治疗、绷带加压包扎、功能锻炼的六步综合消肿疗法,每天1次,20次为一个疗程。结果 治疗20次后,患者患肢最大周径值、节段细胞外水分显著低于治疗前,生物电阻抗值及生活质量显著高于治疗前（均P＜0.01）。结论 六步综合消肿疗法可以改善宫颈癌术后下肢淋巴水肿,提高患者生活质量,促进患者康复。