Department of Surgical Oncology, Miller School of Medicine, University of Miami, Miami, FL.
Ann Surg. 2019 Dec;270(6):1156-1160. doi: 10.1097/SLA.0000000000002827.
To assess the efficiency of Simplified Lymphatic Microsurgical Preventing Healing Approach (S-LYMPHA) in preventing lymphedema (LE) in a prospective cohort of patients.
LE is a serious complication of axillary lymph node dissection (ALND) with an incidence rate of 25%. LYMPHA has been proposed as an effective adjunct to ALND for the prevention of LE. This procedure, however, requires microsurgical techniques and significant coordination between services.
All patients, undergoing ALND with or without S-LYMPHA between January 2014 and December 2016 were included in the study. During follow-up visits, tape-measuring limb circumference method was used to detect LE. The incidence of LE was compared between ALND with and without S-LYMPHA.
A total of 380 patients were included in the analysis. Median follow-up time was 15 (1-32) months. Patients, who underwent S-LYMPHA, had a significantly lower rate of LE both in univariate and multivariate analysis [3% vs 19%; P = 0.001; odds ratio 0.12 (0.03-0.5)]. Excising more than 22 lymph nodes and a co-diagnosis of diabetes mellitus were also correlated with higher clinical LE rates on univariate analysis, but only excising more than 22 lymph nodes remained to be significant on multivariate analysis.
S-LYMPHA is a simple method, which decreases incidence of LE dramatically. It should be considered as an adjunct procedure to ALND for all patients during initial surgery.
评估简化淋巴显微预防治疗方法（S-LYMPHA）在预防前瞻性队列患者淋巴水肿（LE）中的效果。
LE 是腋窝淋巴结清扫术（ALND）的严重并发症，发病率为 25%。LYMPHA 已被提议作为 ALND 预防 LE 的有效辅助方法。然而，该手术需要显微外科技术和服务之间的高度协调。
所有于 2014 年 1 月至 2016 年 12 月期间接受 ALND 联合或不联合 S-LYMPHA 的患者均被纳入研究。在随访期间，采用胶带测量肢体周长的方法检测 LE。比较 ALND 联合和不联合 S-LYMPHA 的 LE 发生率。
共纳入 380 例患者进行分析。中位随访时间为 15 个月（1-32 个月）。S-LYMPHA 组 LE 发生率在单因素和多因素分析中均显著降低[3%比 19%；P=0.001；比值比 0.12（0.03-0.5）]。单因素分析中，切除超过 22 个淋巴结和合并糖尿病与 LE 发生率升高相关，但仅切除超过 22 个淋巴结在多因素分析中仍具有统计学意义。
S-LYMPHA 是一种简单的方法，可显著降低 LE 的发生率。在初始手术时，应将其视为 ALND 的辅助方法，适用于所有患者。
