上肢淋巴水肿：自体淋巴管移植后淋巴动力学动态成像评估功能结局。

Lymphedema of the upper limb: evaluation of the functional outcome by dynamic imaging of lymph kinetics after autologous lymph vessel transplantation.

机构信息

From the Departments of *Nuclear Medicine, and †Micro, Hand, and Reconstructive Surgery, Ludwig-Maximilians-University of Munich; and ‡Chirurgische Klinik Munich-Bogenhausen, Munich, Germany.

出版信息

Clin Nucl Med. 2015 Feb;40(2):e117-23. doi: 10.1097/RLU.0000000000000579.

DOI:10.1097/RLU.0000000000000579

PMID:25243943

Abstract

PURPOSE

The aim of this study was to evaluate by lymphoscintigraphy the functional outcome after autologous lymph vessel transplantation (Tx) of the upper limb.

METHODS

One hundred seventy-seven patients (172 female, 5 male; median age, 56 years; range, 12-84 years) presenting with Tx situs in an upper limb were included. For correlation of scintigraphic data versus reduction of volume (RV) surplus measurements, we examined at 4 different time points as follows: preoperatively (T0), within 2 weeks after Tx (T1), 6 to 12 months after Tx (T2), and 32 to 38 months after Tx (T3). An additional long-term follow-up after at least 8 years (T4) was available in some cases.

RESULTS

The maximum individual postoperative observation period was 19 years. In 169 of 177 cases, lymphedema had been caused by treatment of breast cancer (mastectomy, n = 103/169; breast preserving, n = 66/169) and/or radiation therapy (n = 130/177), but 2 patients presented with primary lymphedema. The remaining 6 cases of lymphatic disorders were caused by treatment of malignant melanoma, Hodgkin lymphoma, axillary Ewing sarcoma, non-Hodgkin lymphoma, hemangioma, or abscess removal.At T1, the mean RV of the affected limb was 73%, and the mean improvement of transport index (TI) was 28%. At T2, the RV was 64% and the TI was 23%, and at T3, the RV was 63% and the TI was 25%. Long-term follow-up after at least 8 years (T4: range, 9-19.2; mean, 14.1 years) was available in 19 of 177 patients, in whom persistent improvement in the scintigraphic data (25% decrease in TI) was confirmed by a mean clinical RV of 68%. The mean overall correlation was by a factor of 2.64.

CONCLUSIONS

Our findings in this large set of patients undergoing autologous lymph vessel Tx to an upper limb confirm that this microsurgical technique significantly and persistently improves lymph drainage in patients with lymphedema. The findings of lymphoscintigraphy correlated well with volume measurements at long-term follow-up.

摘要

目的

本研究旨在通过淋巴闪烁显像术评估自体淋巴管移植（Tx）上肢后的功能结果。

方法

纳入 177 例上肢 Tx 部位患者（172 例女性，5 例男性；中位年龄 56 岁；范围 12-84 岁）。为了将闪烁显像数据与体积（RV）剩余测量值相关联，我们在以下 4 个不同时间点进行了检查：术前（T0）、Tx 后 2 周内（T1）、Tx 后 6-12 个月（T2）和 Tx 后 32-38 个月（T3）。在某些情况下，还可获得至少 8 年后的额外长期随访（T4）。

结果

177 例患者中，169 例因乳腺癌（乳房切除术，n=103/169；保乳治疗，n=66/169）和/或放射治疗（n=130/177）而导致淋巴水肿，2 例为原发性淋巴水肿。其余 6 例淋巴系统疾病由恶性黑色素瘤、霍奇金淋巴瘤、腋窝尤文肉瘤、非霍奇金淋巴瘤、血管瘤或脓肿切除治疗引起。在 T1 时，患侧肢体的平均 RV 为 73%，平均转运指数（TI）改善 28%。在 T2 时，RV 为 64%，TI 为 23%，在 T3 时，RV 为 63%，TI 为 25%。177 例患者中有 19 例（范围，9-19.2；平均，14.1 年）进行了至少 8 年的长期随访（T4），通过平均临床 RV 为 68%证实了 TI 下降 25%的闪烁显像数据的持续改善。平均总体相关性为 2.64 倍。