Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Department of Plastic Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
Microsurgery. 2021 Nov;41(8):802-815. doi: 10.1002/micr.30812. Epub 2021 Sep 25.
As a promising treatment for lymphedema, vascularized lymph node transfer (VLNT) is associated with a risk of iatrogenic lymphedema. Intra-abdominal vascularized lymph node flap has been increasingly applied to minimize complication.
PubMed, EMBASE, Web of Sciences, and Cochrane databases were searched systematically. Clinical articles describing the application of intra-abdominal flaps to treat lymphedema were included. Study characteristics, patient demographics, and operative details were recorded. Primary outcomes were recorded as circumference/volume reduction, episodes of cellulitis reduction and lymph flow assessment. Secondary outcomes were recorded as donor-site complication and recipient-site complication.
Twenty-one studies met the inclusion criteria with 594 patients in total. Donor-sites of flaps were omental/gastroepiploic, jejunal, ileocecal, and appendicular. The mean reduction rate ranged from 0.38% to 70.8%. Significant reduction in infectious episodes was reported in 10 studies. The pooled donor-site complication rate was 1.4% (95% CI, 0%-4.1%; I = 40%). The pooled recipient-site complication rate was 3.2% (95% CI, 1.4%-5.5%; I = 39%). The most common donor-site complication was minor ileus requiring prolonged nasogastric tube replacement. No donor site lymph disfunction occurred.
Intra-abdominal VLNT is an effective technique for patients with lymphedema with no obvious impairment to donor-site lymph function, as long as the operation is properly performed.
作为淋巴水肿的一种有前途的治疗方法，带血管的淋巴结转移（VLNT）有发生医源性淋巴水肿的风险。腹腔内带血管的淋巴结皮瓣的应用越来越多，以尽量减少并发症。
系统地检索了 PubMed、EMBASE、Web of Sciences 和 Cochrane 数据库。纳入了描述应用腹腔内皮瓣治疗淋巴水肿的临床文章。记录了研究特征、患者人口统计学和手术细节。主要结局记录为周长/体积减少、蜂窝织炎发作减少和淋巴流量评估。次要结局记录为供区并发症和受区并发症。
21 项研究符合纳入标准，共 594 例患者。皮瓣的供区为网膜/胃网膜、空肠、回盲肠和阑尾。平均减少率为 0.38%至 70.8%。10 项研究报告了感染发作的显著减少。汇总的供区并发症发生率为 1.4%（95%CI，0%-4.1%；I²=40%）。汇总的受区并发症发生率为 3.2%（95%CI，1.4%-5.5%；I²=39%）。最常见的供区并发症是需要长时间鼻胃管替代的轻微肠梗阻。没有发生供区淋巴功能障碍。
只要手术操作得当，腹腔内 VLNT 是治疗淋巴水肿患者的有效技术，不会明显损害供区的淋巴功能。
