Patel Ketan M, Lin Chia-Yu, Cheng Ming-Huei
Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Ann Surg Oncol. 2015 Jul;22(7):2424-30. doi: 10.1245/s10434-014-4276-3. Epub 2014 Dec 17.
Microsurgical techniques for the treatment of lymphedema rapidly increased in popularity. Although surgical success with vascularized lymph node (VLN) transfer has been demonstrated, limited studies have investigated the influence of microsurgical treatments on health-related quality-of-life (HRQoL) parameters. The aim of this study was to prospectively evaluate changes in HRQoL following VLN transfer for upper- and lower-extremity lymphedema using a validated instrument.
An Institutional Review Board-approved prospective study was performed of patients who underwent VLN transfer for symptomatic upper- or lower-limb lymphedema. A validated lymphedema-specific questionnaire-lymphoedema quality-of-life study-was utilized to assess specific quality-of-life parameters at multiple time points during the 12-month perioperative period. For a comparison with HRQoL metrics, limb circumference measurements were obtained to assess circumference differentiation.
Twenty-five patients met the study criteria. Limb circumference analysis revealed significant early improvements following VLN transfer, with continued improvement during the study period (upper-limb lymphedema: 24.4 %; lower-limb lymphedema: 35.2 %). These improvements were mirrored by improvements in all HRQoL domains and overall quality of life (p < 0.01). The function, body appearance, symptom, and mood domains were all found to be significantly improved during the postoperative evaluation, with continued improvement being reported throughout the study period (p < 0.01 within each domain).
Microsurgical treatment of lymphedema with VLN transfer procedures effectively decrease limb circumference. This improvement is mirrored by improvements in patient-reported outcomes and quality of life. These changes can be observed as soon as 1 month postoperatively, and continued steady improvement can be expected.
用于治疗淋巴水肿的显微外科技术迅速普及。尽管已证实带血管淋巴结（VLN）转移手术取得成功，但关于显微外科治疗对健康相关生活质量（HRQoL）参数影响的研究有限。本研究的目的是使用经过验证的工具，前瞻性评估上肢和下肢淋巴水肿患者接受VLN转移术后HRQoL的变化。
对因症状性上肢或下肢淋巴水肿接受VLN转移手术的患者进行了一项经机构审查委员会批准的前瞻性研究。使用经过验证的特定于淋巴水肿的问卷——淋巴水肿生活质量研究，在12个月围手术期的多个时间点评估特定的生活质量参数。为了与HRQoL指标进行比较，测量肢体周长以评估周长差异。
25名患者符合研究标准。肢体周长分析显示，VLN转移术后早期有显著改善，且在研究期间持续改善（上肢淋巴水肿：24.4%；下肢淋巴水肿：35.2%）。所有HRQoL领域和总体生活质量的改善反映了这些变化（p<0.01）。在术后评估中，功能、身体外观、症状和情绪领域均有显著改善，且在整个研究期间持续改善（每个领域内p<0.01）。
采用VLN转移手术进行显微外科治疗淋巴水肿可有效减小肢体周长。患者报告的结局和生活质量的改善反映了这一改善。这些变化在术后1个月即可观察到，且有望持续稳步改善。
