与淋巴管硬化相关的因素：对962条淋巴管的分析
Factors Associated with Lymphosclerosis: An Analysis on 962 Lymphatic Vessels.
作者信息
Yamamoto Takumi, Yamamoto Nana, Yoshimatsu Hidehiko, Narushima Mitsunaga, Koshima Isao
机构信息
Tokyo, Japan.
From the Department of Plastic Surgery, Tokyo Metropolitan Bokutoh Hospital; and the Department of Plastic and Reconstructive Surgery, University of Tokyo Hospital.
出版信息
Plast Reconstr Surg. 2017 Oct;140(4):734-741. doi: 10.1097/PRS.0000000000003690.
BACKGROUND
Lymphaticovenular anastomosis is a useful treatment option for compression-refractory lower extremity lymphedema, but its efficacy depends largely on the severity of lymphosclerosis. To maximize lymphaticovenular anastomosis efficacy, it is important to elucidate factors associated with severe lymphosclerosis.
METHODS
Medical charts of 134 lower extremity lymphedema patients who underwent preoperative indocyanine green lymphography and lymphaticovenular anastomosis were reviewed to obtain data of clinical demographics, indocyanine green lymphography findings, and intraoperative findings. Based on intraoperative findings of lymphatic vessels, severity of lymphosclerosis was classified into s0, s1, s2, and s3. Severe lymphosclerosis was defined as lymphatic vessels with s3 sclerosis. Logistic regression analysis was used to identify independent factors associated with severe lymphosclerosis.
RESULTS
In total, 962 lymphatic vessels were analyzed, among which severe lymphosclerosis was observed in 97 (10.1 percent). Multivariate analysis revealed that independent factors associated with severe lymphosclerosis were higher body mass index (OR, 1.803; 95 percent CI, 1.041 to 3.123; p = 0.035), incision site in the thigh/foot compared with in the groin (OR, 2.355/4.471; 95 percent CI, 1.201 to 4.617/2.135 to 9.362; p = 0.013/p < 0.001), and S-region/D-region on indocyanine green lymphography compared with L-region (OR, 83.134/1441.126; 95 percent CI, 11.296 to 611.843/146.782 to 14149.195; p < 0.001/p < 0.001). Inverse associations were observed in positive history of radiation therapy (OR, 0.461; 95 percent CI, 0.269 to 0.788; p = 0.005).
CONCLUSIONS
Independent factors associated with severe lymphosclerosis were clarified. Indocyanine green lymphography pattern had the strongest association with severe lymphosclerosis. D-region on indocyanine green lymphography should be avoided for lymphaticovenular anastomosis.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
背景
淋巴管静脉吻合术是治疗压迫难治性下肢淋巴水肿的一种有效方法，但其疗效很大程度上取决于淋巴硬化的严重程度。为了使淋巴管静脉吻合术的疗效最大化，阐明与严重淋巴硬化相关的因素很重要。
方法
回顾了134例接受术前吲哚菁绿淋巴造影和淋巴管静脉吻合术的下肢淋巴水肿患者的病历，以获取临床人口统计学数据、吲哚菁绿淋巴造影结果和术中发现。根据术中淋巴管的发现，将淋巴硬化的严重程度分为s0、s1、s2和s3。严重淋巴硬化定义为s3级硬化的淋巴管。采用逻辑回归分析确定与严重淋巴硬化相关的独立因素。
结果
共分析了962条淋巴管，其中97条（10.1%）观察到严重淋巴硬化。多因素分析显示，与严重淋巴硬化相关的独立因素包括较高的体重指数（比值比[OR]，1.803；95%置信区间[CI]，1.041至3.123；P = 0.035）、大腿/足部与腹股沟相比的切口部位（OR，2.355/4.471；95%CI，1.201至4.617/2.135至9.362；P = 0.013/P < 0.001）以及吲哚菁绿淋巴造影上的S区/D区与L区相比（OR，83.134/1441.126；95%CI，11.296至611.843/146.782至14149.195；P < 0.001/P < 0.001）。放疗阳性史存在负相关（OR，0.461；95%CI，0.269至0.788；P = 0.005）。
结论
明确了与严重淋巴硬化相关的独立因素。吲哚菁绿淋巴造影模式与严重淋巴硬化的相关性最强。淋巴管静脉吻合术应避免吲哚菁绿淋巴造影上的D区。
临床问题/证据水平：风险，III级
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