Yang Johnson Chia-Shen, Wang Yu-Ming, Wu Shao-Chun, Lin Wei-Che, Chien Peng-Chen, Tsai Pei-Yu, Hsieh Ching-Hua, Luo Sheng-Dean
Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan.
College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
J Clin Med. 2022 May 30;11(11):3089. doi: 10.3390/jcm11113089.
Despite an increased incidence of secondary lower limb lymphedema (LLL) and severity of comorbidities with age, the impact of age on the effectiveness of lymphaticovenous anastomosis (LVA) in the older patients remains unclear. Methods: This retrospective cohort study enrolled older patients (age > 65 years) with secondary unilateral LLL. All patients underwent supermicrosurgical LVA. Demographic data and intraoperative findings including lymphatic vessel (LV) diameter, LV functionality (indocyanine green-enhanced and Flow positivity), and lymphosclerosis classification were recorded. Magnetic resonance volumetry was used for measuring preoperative and postoperative volume changes at 6 months and one year after LVA as primary and secondary endpoints. Results: Thirty-two patients (29 females/3 males) with a median age of 71.0 years [range, 68.0 to 76.3] were enrolled. The median duration of lymphedema was 6.4 [1.0 to 11.7] years. The median LV diameter was 0.7 [0.5 to 0.8] mm. The percentage of ICG-enhanced and Flow-positive LVs were 89.5% and 85.8%, respectively. The total percentage of suitable LVs (s0 and s1) for LVA based on lymphosclerosis classification was 75.9%. There were significant six-month and one-year post-LVA percentage volume reductions compared to pre-LVA volume (both p < 0.001). A significant reduction in cellulitis incidence was also noted after LVA (p < 0.001). No surgical or postoperative complications were found. Conclusion: Relief of secondary LLL was achievable through LVA in older patients who still possessed favorable LV characteristics, including larger LV diameters as well as a high proportion of functional LVs with a low grade of lymphosclerosis.
尽管继发性下肢淋巴水肿（LLL）的发病率随年龄增长而增加，且合并症的严重程度也随年龄增长而加重，但年龄对老年患者淋巴管静脉吻合术（LVA）疗效的影响仍不明确。方法：本回顾性队列研究纳入了年龄大于65岁的继发性单侧LLL老年患者。所有患者均接受了超显微外科LVA手术。记录人口统计学数据和术中发现，包括淋巴管（LV）直径、LV功能（吲哚菁绿增强和血流阳性）以及淋巴硬化分类。以LVA术后6个月和1年的术前和术后体积变化作为主要和次要终点，采用磁共振容积测量法进行测量。结果：共纳入32例患者（29例女性/3例男性），中位年龄为71.0岁[范围，68.0至76.3岁]。淋巴水肿的中位持续时间为6.4[1.0至11.7]年。LV的中位直径为0.7[0.5至0.8]mm。吲哚菁绿增强和血流阳性的LV的百分比分别为89.5%和85.8%。根据淋巴硬化分类，适合进行LVA的LV（s0和s1）的总百分比为75.9%。与LVA术前相比，术后6个月和1年的体积百分比有显著降低（均p<0.001）。LVA术后蜂窝织炎的发生率也显著降低（p<0.001）。未发现手术或术后并发症。结论：对于仍具有良好LV特征的老年患者，包括较大的LV直径以及高比例的功能良好且淋巴硬化程度低的LV，通过LVA可实现继发性LLL的缓解。
