Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy.
Department of Cardio-Thoracic-Vascular and Endovascular Surgery, San Martino Polyclinic Hospital, Genoa, Italy.
Microsurgery. 2022 Oct;42(7):668-676. doi: 10.1002/micr.30944. Epub 2022 Aug 2.
Lymphedema is always initially treated by combined decongestive physiotherapy (CDP). Those cases, refractory to CDP, may be managed by surgical therapy. One of the most used microsurgical procedures is represented by the technique of lymphatic-venous anastomosis (LVA). But very few papers report long term results of LVA. The aim of this study is to assess the long-term patency of multiple lymphatic-venous anastomosis (MLVA) for the treatment of secondary lymphedemas.
From January 2014 to December 2014, 101 patients (mean age: 56.94 ± 8.98 years; female/male: 86/15) affected by secondary cancer-related lymphedema (38 lower and 63 upper limbs) were treated by MLVA. All lymphedemas had previously been treated by conservative therapy without sustained results. Many patients (78%) had 1-3 episodes of acute lymphangitis/year. Lymphoscintigraphy, venous duplex-ultrasonography, and abdominal or axillary ultrasound investigation were performed preoperatively. MLVA patency was assessed by the lymphatic transport index (LyTI) and lymphoscintigraphic pattern.
At 1 year after surgery, excess volume reduction was 75%-90% in the early stage II secondary lymphedemas, and 60%-75% in the late stage II. The decrease in volume maintained stability in the 5-years follow-up period. Two more advanced lower and one upper limb lymphedemas had 45%-60% reduction. LyTI showed a significant decrease between the preoperative mean value (31.7 ± 9.43) and after 18 months from surgery (11.2 ± 1.91) (p < .001). MLVA patency was shown in 98 (97%) patients. No patients had evidence of postoperative lymphangitis.
This study demonstrated the long-term patency of MLVA in the treatment of cancer-related lymphedemas.
淋巴水肿最初总是通过联合减压物理疗法（CDP）进行治疗。那些对 CDP 有抗药性的病例可能需要手术治疗。最常用的显微外科手术之一是淋巴管静脉吻合术（LVA）。但是，很少有论文报道 LVA 的长期结果。本研究旨在评估用于治疗继发性淋巴水肿的多次淋巴管静脉吻合术（MLVA）的长期通畅情况。
2014 年 1 月至 2014 年 12 月，101 例（平均年龄：56.94±8.98 岁；女性/男性：86/15）患有继发性癌症相关淋巴水肿（38 例下肢和 63 例上肢）的患者接受了 MLVA 治疗。所有的淋巴水肿先前都经过了保守治疗，但没有持续的效果。许多患者（78%）每年有 1-3 次急性淋巴管炎/年。术前进行淋巴闪烁显像、静脉双功能超声检查以及腹部或腋窝超声检查。通过淋巴转运指数（LyTI）和淋巴闪烁显像模式评估 MLVA 通畅性。
术后 1 年，早期 II 期继发性淋巴水肿的过量体积减少 75%-90%，晚期 II 期的减少 60%-75%。在 5 年的随访期间，体积减少保持稳定。另外两个更严重的下肢和一个上肢淋巴水肿的减少量为 45%-60%。LyTI 在术前平均值（31.7±9.43）和术后 18 个月（11.2±1.91）之间有显著下降（p<0.001）。98 例（97%）患者显示 MLVA 通畅。没有患者出现术后淋巴管炎的证据。
本研究表明 MLVA 在治疗癌症相关淋巴水肿方面具有长期通畅性。
