Qiu Shan S, Pruimboom Tim, Cornelissen Anouk J M, Schols Rutger M, van Kuijk Sander M J, van der Hulst René R W J
Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
Breast Cancer Res Treat. 2020 Nov;184(1):173-183. doi: 10.1007/s10549-020-05839-4. Epub 2020 Aug 7.
Lymphedema is a debilitating condition that significantly affects patient's quality of life (QoL). The aim of this study was to assess the long-term outcomes after lymphaticovenous anastomosis (LVA) for extremity lymphedema.
A single-center prospective study on upper and lower extremity lymphedema patients was performed. All LVA procedures were preceded by outpatient Indocyanine Green (ICG) lymphography. Quality of life measured by the Lymph-ICF was the primary outcome. Limb circumference, use of compression garments, and frequency of cellulitis episodes and manual lymphatic drainage (MLD) sessions were secondary outcomes.
One hundred consecutive patients, predominantly experiencing upper extremity lymphedema following breast cancer (n = 85), underwent a total of 132 LVAs. During a mean follow-up of 25 months, mean Lymph-ICF score significantly decreased from 43.9 preoperative to 30.6 postoperative, representing significant QoL improvement. Decrease in upper and lower limb circumference was observed in 52% of patients with a mean decrease of 6%. Overall mean circumference was not significantly different. Percentage of patients that could reduce compression garments in the upper and lower extremity group was 65% and 40%, respectively. Number of cellulitis episodes per year and MLD sessions per week showed a mean decrease of respectively 0.6 and 0.8 in the upper extremity and 0.4 and 1.0 in the lower extremity group.
LVA resulted in significant QoL improvement in upper and lower extremity lymphedema patients. Limb circumference did not significantly improve but good results concerning compression garments, cellulitis episodes, and MLD sessions were obtained. Additionally, a simple and patient-friendly method for outpatient ICG lymphography is presented.
淋巴水肿是一种使人衰弱的病症，会显著影响患者的生活质量（QoL）。本研究的目的是评估肢体淋巴水肿行淋巴管静脉吻合术（LVA）后的长期疗效。
对上肢和下肢淋巴水肿患者进行了一项单中心前瞻性研究。所有LVA手术前均进行门诊吲哚菁绿（ICG）淋巴造影。以淋巴国际功能、残疾和健康分类（Lymph-ICF）测量的生活质量为主要结局。肢体周长、压力衣的使用、蜂窝织炎发作频率和手法淋巴引流（MLD）次数为次要结局。
连续100例患者主要经历乳腺癌后上肢淋巴水肿（n = 85），共接受了132次LVA手术。在平均25个月的随访期间，Lymph-ICF平均评分从术前的43.9显著降至术后的30.6，表明生活质量有显著改善。52%的患者上肢和下肢周长减小，平均减小6%。总体平均周长无显著差异。上肢和下肢组能够减少压力衣使用的患者百分比分别为65%和40%。上肢组每年蜂窝织炎发作次数和每周MLD次数平均分别减少0.6和0.8，下肢组分别减少0.4和1.0。
LVA使上肢和下肢淋巴水肿患者的生活质量得到显著改善。肢体周长虽无显著改善，但在压力衣、蜂窝织炎发作次数和MLD次数方面取得了良好效果。此外，还介绍了一种简单且患者友好的门诊ICG淋巴造影方法。
