Damstra R J, Voesten H G J, van Schelven W D, van der Lei B
Department of Dermatology, Phlebology and Lymphology, Nij Smellinghe Hospital, Compagnonsplein 1, 9202 NN, Drachten, The Netherlands.
Breast Cancer Res Treat. 2009 Jan;113(2):199-206. doi: 10.1007/s10549-008-9932-5. Epub 2008 Feb 13.
The incidence of breast cancer related lymphedema (BCRL) varies between 7-35% depending on the combination of treatment modalities. Early detection of BCRL is crucial in order to start an effective non-operative treatment program. Because of the lack of prospective research on this topic, this study was undertaken to prospectively determine the effect of Lympho Venous Anastomosis (LVA) on BCRL and to review the current literature.
Ten patients who were previously treated for breast cancer by surgery, radiotherapy, and chemotherapy, and were unresponsive to 12-weeks of non-operative treatment, underwent an LVA procedure (Degni-Cordeiro). Objective measurements were gathered for circumferential measurement and water volumetry, and quality of life. Various types of lymphoscintigraphy were carried out pre-operatively and post-operatively at 3 and 12 months. Treatment was embedded in a multidisciplinary setting.
Post-operative volume measurements initially showed a 4.8% reduction of lymphedema at 3 months and a 2% reduction after one year. Various scintigraphic parameters showed some improvement. Quality of life questionnaires reported minimal improvement. Reviewing the literature, only retrospective studies were found; these reported varying results for LVA procedures. The selection of patients, classification of lymphedema, indications and types of LVA, and additional therapeutic options were heterogeneous, not comparable, and lacked a validated method of effect-assessment.
Our results showed a minimal reduction in volume of lymphedema following LVA; in the literature, there was no convincing evidence of the success of LVA. Non-operative treatment and elastic stockings are still preferred by most patients with lymphedema, especially in early stages with few irreversible changes.
根据治疗方式的组合不同，乳腺癌相关淋巴水肿（BCRL）的发生率在7%至35%之间波动。早期发现BCRL对于启动有效的非手术治疗方案至关重要。由于缺乏关于该主题的前瞻性研究，本研究旨在前瞻性地确定淋巴静脉吻合术（LVA）对BCRL的影响，并对当前文献进行综述。
10例曾接受过乳腺癌手术、放疗和化疗且对12周非手术治疗无反应的患者接受了LVA手术（Degni-Cordeiro术式）。收集了客观测量数据，包括周径测量、水容量测定以及生活质量评估。术前及术后3个月和12个月进行了各种类型的淋巴闪烁显像检查。治疗纳入多学科环境中。
术后容量测量最初显示3个月时淋巴水肿减少4.8%，1年后减少2%。各种闪烁显像参数显示有一定改善。生活质量问卷显示改善甚微。回顾文献，仅发现回顾性研究；这些研究报告的LVA手术结果各异。患者选择、淋巴水肿分类、LVA的适应症和类型以及其他治疗选择存在异质性，不可比，且缺乏经过验证的疗效评估方法。
我们的结果显示LVA术后淋巴水肿体积仅有轻微减少；在文献中，没有令人信服的证据表明LVA手术成功。大多数淋巴水肿患者仍然更喜欢非手术治疗和弹力袜，尤其是在早期且不可逆变化较少的阶段。
