Cheng Ming-Huei, Loh Charles Yuen Yung, Lin Chia-Yu
Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Plast Reconstr Surg Glob Open. 2018 Dec 20;6(12):e2056. doi: 10.1097/GOX.0000000000002056. eCollection 2018 Dec.
Primary lymphedema is a debilitating disease. This study was to investigate the outcomes between vascularized lymph node transfer (VLNT) and lymphovenous anastomosis (LVA) for treating primary lymphedema.
Between January 2010 and December 2016, 17 patients with mean age of 31.5 ± 15.5 (ranged, 2-57) years diagnosed with 19 primary limb lymphedema were recruited. Patients with patent lymphatic ducts on indocyanine green lymphography were indicated for LVA, whereas those without patent lymphatic ducts were indicated for VLNT. Circumferential limb measurements, body weight, episodes of cellulitis and Lymphedema Quality-of-Life (LYMQoL) questionnaire were compared between preoperatively and postoperatively.
Fifteen lymphedematous limbs underwent VLNT (79%) and 4 underwent LVA (21%). All VLNT flaps survived. At a mean follow-up of 19.7 ± 8.5 months, mean reduction of limb circumference, body weight, and episodes of cellulitis were 3.7 ± 2.9 cm and 1.9 ± 2.9 cm ( = 0.2); 6.6 ± 5.9 kg and 1.7 ± 0.6 kg ( < 0.05); 5.1 ± 2.8 times/y and 4.2 ± 0.5 times/y in VLNT and LVA groups, respectively ( = 0.7). Improvements in overall score (from 3.9 ± 1.2 to 6.4 ± 1.1, < 0.05) of the LYMQoL in VLNT group had statistical significant difference than that (from 3.0 ± 1.4 to 5.0 ± 2.4, = 0.07) in LVA group.
Both VLNT and LVA can effectively treat primary lymphedema patients. The reduction of above-knee circumference, body weight, episodes of cellulitis, and the improvement of LYMQoL was significantly greater in LVNT compared with LVA.
原发性淋巴水肿是一种使人衰弱的疾病。本研究旨在调查血管化淋巴结转移（VLNT）和淋巴管静脉吻合术（LVA）治疗原发性淋巴水肿的效果。
2010年1月至2016年12月，招募了17例平均年龄为31.5±15.5（范围2 - 57）岁、诊断为19例原发性肢体淋巴水肿的患者。吲哚菁绿淋巴造影显示淋巴管通畅的患者适合LVA，而淋巴管不通畅的患者适合VLNT。比较术前和术后的肢体周径测量值、体重、蜂窝织炎发作次数以及淋巴水肿生活质量（LYMQoL）问卷。
15条淋巴水肿肢体接受了VLNT（79%），4条接受了LVA（21%）。所有VLNT皮瓣均存活。平均随访19.7±8.5个月时，VLNT组和LVA组的肢体周径平均减少量分别为3.7±2.9 cm和1.9±2.9 cm（P = 0.2）；体重分别减少6.6±5.9 kg和1.7±0.6 kg（P < 0.05）；蜂窝织炎发作次数分别为5.1±2.8次/年和4.2±0.5次/年（P = 0.7）。VLNT组LYMQoL的总体评分（从3.9±1.2提高到6.4±1.1，P < 0.05）与LVA组（从3.0±1.4提高到5.0±2.4，P = 0.07）相比有统计学显著差异。
VLNT和LVA均可有效治疗原发性淋巴水肿患者。与LVA相比，LVNT在减少膝上周长、体重、蜂窝织炎发作次数以及改善LYMQoL方面更为显著。
