Department of Surgery, Unit of Lymphatic Surgery, G. Gaslini Institute, Genoa, Italy.
Lymphology. 2013 Mar;46(1):20-6.
Despite the development of minimal access dissection techniques, use of superficial groin dissection alone, and other recommendations to reduce morbidity in melanoma treatment, the incidence of lymphedema is still significant. The purpose of the current study was to assess the efficacy of microsurgical methods to limit the morbidity of inguinal lymphadenectomy. We conducted a retrospective review of patients who underwent groin dissection for melanoma treatment from February 2006 to April 2009. A total of 59 melanoma patients with positive groin lymph nodes comprised 18 patients (T-group) with melanoma in the trunk and 41 patients (E-group) who had melanoma in an extremity and currently have lymphedema. The T-group patients underwent primary prevention of lymphedema with microsurgical lymphatic-venous anastomoses (LVA) performed simultaneously with groin dissection. The E-group patients underwent LVA to treat the secondary lymphedema after an accurate oncological and lymphological assessment. Limb volume measurements and lymphoscintigraphy were performed pre- and postoperatively to assess short and long term outcome. No lymphedema occurred after microsurgical primary preventive approach in the T- group. Significant (average 80% reduction of pre-op excess volume) reduction of lymphedema resulted after microsurgical treatment for secondary leg lymphedema. Post-operative lymphoscintigraphy in 35 patients demonstrated patency of microsurgical anastomoses in all cases with an average follow-up of 42 months. Study results demonstrate that microsurgical LVA primary prevention prevented lymphedema after inguinal lymphadenectomy in the T-group patients. In addition, lymphatic-venous multiple anastomoses proved to be a successful treatment for clinical lymphedema with particular success if treated at the early stages.
尽管微创解剖技术、单独使用浅表腹股沟解剖和其他减少黑色素瘤治疗发病率的建议已经发展，但淋巴水肿的发病率仍然很高。本研究的目的是评估限制腹股沟淋巴结清扫术发病率的显微外科方法的疗效。我们对 2006 年 2 月至 2009 年 4 月期间因黑色素瘤治疗而行腹股沟解剖的患者进行了回顾性研究。共有 59 例腹股沟淋巴结阳性的黑色素瘤患者，其中 18 例（T 组）为躯干黑色素瘤患者，41 例（E 组）为肢体黑色素瘤患者，目前患有淋巴水肿。T 组患者在腹股沟解剖的同时进行了显微外科淋巴管静脉吻合术（LVA）以预防淋巴水肿。E 组患者在经过准确的肿瘤学和淋巴学评估后，行 LVA 治疗继发性淋巴水肿。术前和术后进行肢体体积测量和淋巴闪烁显像术，以评估短期和长期结果。T 组患者行显微外科预防性治疗后无淋巴水肿发生。对继发性腿部淋巴水肿进行显微外科治疗后，淋巴水肿显著（术前过量体积平均减少 80%）。35 例患者的术后淋巴闪烁显像术显示所有病例的显微吻合术通畅，平均随访 42 个月。研究结果表明，T 组患者行腹股沟淋巴结清扫术后，显微外科 LVA 预防性治疗可预防淋巴水肿。此外，淋巴管静脉多吻合术已被证明是治疗临床淋巴水肿的一种成功方法，尤其是在早期治疗时效果更佳。
