Giacalone Guido, Yamamoto Takumi
Department of Lymphatic Surgery, AZ Sint-Maarten Hospital, Duffel, Belgium.
Department of Plastic Surgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.
Microsurgery. 2017 Sep;37(6):680-683. doi: 10.1002/micr.30139. Epub 2017 Jan 3.
Breast lymphedema (BLE) has been reported as a complication following breast cancer treatment. As for extremity lymphedema treatment, supermicrosurgical lymphaticovenous anastomosis (LVA) is considered an option for the treatment of progressive BLE refractory to conservative treatments, but no case has been reported so far. We report the first case of BLE successfully treated with supermicrosurgical LVA. A 55-year-old female presented with left BLE after breast conserving surgery and axillary lymph node dissection and adjuvant radiotherapy. After the cancer treatments, the patient suffered from pronounced swelling, sensation of tension, and pain of the left breast with frequent episodes of breast cellulitis. Conservative treatments had been performed for 7 years, but were not effective, and the patient was referred for further surgical treatment. Supermicrosurgical LVA was performed at the left breast. LVA surgery resulted in three anastomoses, in which three lymphatic vessels were anastomosed to three nearby veins in an intima-to-intima coaptation manner. After LVA, the left breast decreased in size, and the sensation of tension disappeared. One year postoperatively, the patient had no distress nor cellulitis episode, and was satisfied with the results of normal breast conditions. Although further clinical studies are required to confirm efficacy, supermicrosurgical LVA has the potential to be an option for the treatment of progressive BLE refractory to conservative treatments.
乳腺癌治疗后发生的乳房淋巴水肿（BLE）已被报道为一种并发症。至于肢体淋巴水肿的治疗，超显微外科淋巴管静脉吻合术（LVA）被认为是治疗对保守治疗无效的进行性BLE的一种选择，但目前尚无相关病例报道。我们报告首例成功采用超显微外科LVA治疗的BLE病例。一名55岁女性在保乳手术、腋窝淋巴结清扫及辅助放疗后出现左侧BLE。癌症治疗后，患者左侧乳房出现明显肿胀、紧绷感和疼痛，并频繁发生乳房蜂窝织炎。保守治疗已进行7年，但无效，患者被转诊接受进一步手术治疗。在左侧乳房进行了超显微外科LVA。LVA手术完成了三处吻合，将三根淋巴管以内膜对内膜贴合的方式与附近三根静脉进行了吻合。LVA术后，左侧乳房体积减小，紧绷感消失。术后一年，患者无不适，未发生蜂窝织炎，对乳房恢复正常状态的结果感到满意。尽管需要进一步的临床研究来证实其疗效，但超显微外科LVA有可能成为治疗对保守治疗无效的进行性BLE的一种选择。
