Lee D, Piller N, Hoffner M, Manjer J, Brorson H
Lymphology. 2016 Jun;49(2):85-92.
The objective of this study was to assess erysipelas incidence before and after liposuction treatment for patients suffering from post-mastectomy lymphedema. A prospective cohort study of 130 patients at Skåne University Hospital in Malmö, Sweden with postmastectomy arm lymphedema, who had poor outcomes from prior conservative treatment and clinical signs of subcutaneous adipose tissue hypertrophy, underwent liposuction between 1993-2012. Pre- and postoperative incident data on erysipelas were available for all of them. Mean duration of lymphedema prior to liposuction was 8.8 years (range1-38, standard deviation (SD) 7.0 years). Mean age at liposuction was 63 years (range 39-89, SD 10 years). Total pre-liposuction observation years were 1147, and total post-liposuction observation years were 983. Erysipelas incidence dropped significantly (p<0.001) from 0.47 attacks/year (range 0-5.0, SD 0.8 attacks/year) to 0.06 attacks/year (range 0-3.0, SD 0.3 attacks/year) after liposuction, a reduction of 87%. Also, compared to 76 patients who experienced at least 1 erysipelas episode preoperatively, only 13 patients experienced erysipelas postoperatively. Of the 54 patients who did not have erysipelas preoperatively, 6 patients had erysipelas postoperatively. The total number of erysipelas attacks observed decreased from 534 to 60 bouts after liposuction. The excess arm volume of 1607 ml (range 570-3950, SD 707) was reduced to -43 ml (range -945 to 1390, SD 379) after 6 months and was maintained during the postoperative follow-up period of, at most, 18 years. Our data suggest that liposuction can significantly reduce incidence of erysipelas in patients with post mastectomy arm lymphedema who prior to the intervention suffered one or more attacks.
本研究的目的是评估抽脂治疗对乳房切除术后淋巴水肿患者丹毒发病率的影响。对瑞典马尔默斯科讷大学医院的130例乳房切除术后手臂淋巴水肿患者进行了一项前瞻性队列研究，这些患者先前保守治疗效果不佳且有皮下脂肪组织肥大的临床体征，于1993年至2012年期间接受了抽脂治疗。所有患者均有术前和术后丹毒发病数据。抽脂术前淋巴水肿的平均持续时间为8.8年（范围1至38年，标准差[SD]7.0年）。抽脂时的平均年龄为63岁（范围39至89岁，SD10岁）。抽脂术前的总观察年数为1147年，抽脂术后的总观察年数为983年。抽脂术后丹毒发病率从0.47次/年（范围0至5.0次，SD0.8次/年）显著下降至0.06次/年（范围0至3.0次,SD0.3次/年）（p<0.001），降幅达87%。此外，与术前至少经历1次丹毒发作的76例患者相比，术后只有13例患者发生丹毒。术前无丹毒的54例患者中，有6例术后发生丹毒。抽脂术后观察到的丹毒发作总数从534次降至60次发作。6个月后多余的手臂体积1607毫升（范围570至3950毫升，SD707）降至-43毫升（范围-945至1390毫升，SD379），并在术后最多18年的随访期内保持。我们的数据表明，抽脂可以显著降低乳房切除术后手臂淋巴水肿患者的丹毒发病率，这些患者在干预前曾遭受一次或多次发作。
