Gustafsson Jonas, Chu Sung-Yu, Chan Wen-Hui, Cheng Ming-Huei
From the Departments of Plastic and Reconstructive Surgery and Medical Imaging and Intervention, Chang Gung Memorial Hospital and Chang Gung University, College of Medicine; and the Department of Plastic Surgery, Sahlgrenska University Hospital.
Plast Reconstr Surg. 2018 Oct;142(4):1056-1063. doi: 10.1097/PRS.0000000000004793.
Vascularized lymph node transfer has shown promising results in the treatment of lower limb lymphedema, but little is known about the number of lymph nodes needed for the transfer to achieve optimal results. This study investigated the correlation between number of transferred lymph nodes in submental vascularized lymph node transfer and outcomes regarding limb circumference reduction and cellulitis incidence.
Thirty-five patients who had received vascularized submental lymph node transfer to an ankle for lower limb lymphedema following gynecologic cancer treatment were included in the study. Limb circumference was determined by means of tape measurement preoperatively and postoperatively and was used to calculate the circumferential difference. Ultrasonography was performed postoperatively to determine the number of lymph nodes within the transferred flap. Patients were divided into groups A through C depending on the number of transferred lymph nodes: 1 or 2 (n = 10), 3 or 4 (n = 14), and 5 to 8 (n = 11), respectively.
The mean age of the patients was 60.0 ± 9.2 years. All flaps survived. The mean improvement of circumferential difference for the whole cohort was 19.8 ± 9.2 percent. Groups B and C both had significantly higher improvements in the circumferential difference than group A (p = 0.04 and p = 0.02, respectively), but when compared to each other, the difference was nonsignificant. All groups had significant reductions in the incidence of cellulitis postoperatively.
Submental vascularized lymph node transfer for lower limb lymphedema reduced the incidence of cellulitis, regardless of the number of transferred lymph nodes. The transfer of three or more lymph nodes provided significantly better outcome regarding limb circumference reduction than the transfer of two or fewer lymph nodes.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
带血管蒂淋巴结转移术在治疗下肢淋巴水肿方面已显示出有前景的结果，但对于转移多少个淋巴结才能达到最佳效果知之甚少。本研究调查了颏下带血管蒂淋巴结转移术中转移淋巴结数量与肢体周长减小和蜂窝织炎发生率结果之间的相关性。
本研究纳入了35例因妇科癌症治疗后下肢淋巴水肿而接受颏下带血管蒂淋巴结转移至踝关节的患者。术前和术后通过卷尺测量确定肢体周长，并用于计算周长差异。术后进行超声检查以确定转移皮瓣内的淋巴结数量。根据转移淋巴结的数量将患者分为A组至C组：分别为1个或2个（n = 10）、3个或4个（n = 14）以及5个至8个（n = 11）。
患者的平均年龄为60.0±9.2岁。所有皮瓣均存活。整个队列的周长差异平均改善为19.8±9.2%。B组和C组的周长差异改善均显著高于A组（分别为p = 0.04和p = 0.02），但相互比较时，差异无统计学意义。所有组术后蜂窝织炎的发生率均显著降低。
颏下带血管蒂淋巴结转移术治疗下肢淋巴水肿可降低蜂窝织炎的发生率，无论转移淋巴结的数量如何。转移三个或更多淋巴结在减小肢体周长方面的效果明显优于转移两个或更少淋巴结。
临床问题/证据水平：治疗性，III级
