Akita Shinsuke, Mitsukawa Nobuyuki, Kuriyama Motone, Kubota Yoshitaka, Hasegawa Masakazu, Tokumoto Hideki, Ishigaki Tatsuya, Togawa Takashi, Kuyama Junpei, Satoh Kaneshige
From the *Department of Plastic and Reconstructive Surgery, Chiba Cancer Center; †Department of Plastic, Reconstructive and Aesthetic Surgery, Chiba University, Faculty of Medicine, Chiba; ‡Department of Plastic and Reconstructive Surgery in Kochi Medical School Hospital, Nankoku; and §Division of Nuclear Medicine, Chiba Cancer Center, Chiba, Japan.
Ann Plast Surg. 2015 May;74(5):573-9. doi: 10.1097/SAP.0000000000000513.
Vascularized lymph node transfer has become a popular surgical option to improve lower extremity lymphedema (LEL), although potential donor sites are limited. The free supraclavicular flap with deep cervical lymph nodes has been recently associated with a minimal risk of secondary lymphedema caused by donor site dissection. However, the effectiveness of this procedure has not yet been evaluated.
Vascularized supraclavicular lymph node transfer (VSLNT) was performed for patients with International Society of Lymphology late stage II or more severe LEL. The results were compared with lymphaticovenular anastomosis (LVA) performed for patients with the same stages of severity. To evaluate improvement in lymphatic function, indocyanine green lymphography and lymphoscintigraphy were performed.
Vascularized supraclavicular lymph node transfer was performed in 13 limbs of 13 patients. The results were compared with 43 limbs of 33 patients who underwent multiple LVA. No severe complications were observed in either group. Improvement in lymphatic function, as measured by the LEL index, was 26.5 ± 4.4 and 21.2 ± 2.0 in the VSLNT and LVA groups, respectively. Lymphatic function was improved in 7 cases in the VSLNT group and 10 cases in the LVA group.
Vascularized supraclavicular lymph node transfer is an effective technique for the treatment of advanced stage LEL. Lymphaticovenular anastomosis is also effective, but to a lesser degree than VSLNT. However, LVA is less invasive and requires a shorter hospital stay.
尽管潜在的供区有限，但带血管蒂淋巴结转移术已成为改善下肢淋巴水肿（LEL）的一种常用手术选择。最近，带颈深淋巴结的游离锁骨上皮瓣与供区解剖导致继发性淋巴水肿的风险最小相关。然而，该手术的有效性尚未得到评估。
对国际淋巴学会II期晚期或更严重LEL患者进行带血管蒂锁骨上淋巴结转移术（VSLNT）。将结果与相同严重程度分期患者进行的淋巴管静脉吻合术（LVA）的结果进行比较。为评估淋巴功能的改善情况，进行了吲哚菁绿淋巴造影和淋巴闪烁显像。
对13例患者的13条肢体进行了带血管蒂锁骨上淋巴结转移术。将结果与33例接受多次LVA的患者的43条肢体进行比较。两组均未观察到严重并发症。以LEL指数衡量，VSLNT组和LVA组的淋巴功能改善分别为26.5±4.4和21.2±2.0。VSLNT组7例和LVA组10例的淋巴功能得到改善。
带血管蒂锁骨上淋巴结转移术是治疗晚期LEL的有效技术。淋巴管静脉吻合术也有效，但程度低于VSLNT。然而，LVA的侵入性较小，住院时间较短。
