Seki Yukio, Kajikawa Akiyoshi, Asai Rintaro, Tomochika Mayo, Nemoto Hitoshi, Terashima Takahiro, Kurogi Norimitsu
From the Department of Plastic and Reconstructive Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan.
Department of Plastic and Reconstructive Surgery, Shonan Atsugi Hospital, Atsugi, Kanagawa, Japan.
Plast Reconstr Surg Glob Open. 2023 Aug 9;11(8):e5175. doi: 10.1097/GOX.0000000000005175. eCollection 2023 Aug.
In conservative treatment for breast cancer-related lymphedema (BCRL), compression therapy has a crucial role. However, some BCRL patients are unable to use compression, and then their lymphedema continues to worsen as they miss treatment opportunity. Although lymphaticovenular anastomosis (LVA) is an effective and minimally invasive surgical treatment for BCRL, compression therapy is still important to enhance lymphatic fluid flow in LVA. The authors previously reported the dynamic LVA method for BCRL, in which patient's natural hand movements theoretically propel lymph to the anastomosed vein. This study is conducted to clarify whether dynamic LVA can salvage BCRL patients without pre- and postoperative compression therapy.
The study involved 17 BCRL patients, 18 limbs. All patients had International Society of Lymphology stage-2 lymphedema, but they had no compression: six patients had difficulty by other diseases to undergo compression, and other 11 patients refused any compression usage because of the burden of the treatment itself. Three dynamic LVAs were performed in each patient.
Patients' mean age was 60.4 ± 10.1, and mean body mass index was 24.0 ± 3.3. The mean follow-up period was 25.5 ± 9.2 months. The volume of the lymphedematous limb, according to the upper extremity lymphedema (UEL) index, was reduced in all 18 limbs postoperatively (postoperative UEL index 101.8 ± 9.4 versus preoperative UEL index 116.0 ± 20.1; < 0.01). Twelve of the 18 limbs were cured without edema.
Even without compression therapy, International Society of Lymphology stage-2 BCRL patients can be treated by the dynamic LVA method.
在乳腺癌相关淋巴水肿（BCRL）的保守治疗中，压迫疗法起着关键作用。然而，一些BCRL患者无法使用压迫疗法，由于错过治疗机会，他们的淋巴水肿会持续恶化。尽管淋巴管静脉吻合术（LVA）是一种治疗BCRL的有效且微创的手术方法，但压迫疗法对于增强LVA中的淋巴液流动仍然很重要。作者之前报道了用于BCRL的动态LVA方法，理论上患者的自然手部运动可将淋巴推向吻合静脉。本研究旨在阐明动态LVA能否挽救无需术前和术后压迫疗法的BCRL患者。
本研究纳入了17例BCRL患者，共18条肢体。所有患者均为国际淋巴学会2期淋巴水肿，但均未接受压迫治疗：6例患者因其他疾病难以接受压迫治疗，另外11例患者因治疗本身的负担而拒绝使用任何压迫疗法。每位患者均进行了3次动态LVA手术。
患者的平均年龄为60.4±10.1岁，平均体重指数为24.0±3.3。平均随访期为25.5±9.2个月。根据上肢淋巴水肿（UEL）指数，所有18条肢体的淋巴水肿肢体体积术后均减小（术后UEL指数为101.8±9.4，术前UEL指数为116.0±20.1；<0.01）。18条肢体中有12条治愈且无水肿。
即使不进行压迫疗法，国际淋巴学会2期BCRL患者也可通过动态LVA方法进行治疗。
