Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China.
Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China; Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, Zunyi, China.
J Vasc Surg Venous Lymphat Disord. 2024 Sep;12(5):101905. doi: 10.1016/j.jvsv.2024.101905. Epub 2024 May 16.
Gynecological cancer-related lower extremity lymphedema (GC-LEL), a chronic, progressive condition, lacks a standardized treatment. Currently, supraclavicular vascularized lymph node transfer (SC-VLNT) is a favored approach in the treatment of lymphedema, and there is a trend toward combination technology. This study conducts a comparative analysis of three techniques for treating GC-LEL with simultaneous SC-VLNT and liposuction.
A cohort of 35 patients with GC-LEL was examined, comprising 13 patients who underwent single lymph nodes flap with a skin paddle (SLNF+P), 12 who received single lymph nodes flap without a skin paddle (SLNF), and 10 who accepted dual lymph nodes flap without a skin paddle (DLNF). Patient demographics and outcomes were meticulously documented, covering intra- and postoperative variables.
The median limb volume reduction were 56.4% (SLNF+P), 60.8% (SLNF), and 50.5% (DLNF) in stage II, and 54.0% (SLNF+P), 59.8% (SLNF), and 54.4% (DLNF) in stage III. DLNF group procedures entailed longer flap harvesting and transplantation times. The SLNF+P group, on average, had an 8-day postoperative hospitalization, longer than others. All patients noted subjective improvements in Lymphedema Quality of Life scores, with lymphoscintigraphy revealing enhanced lymphatic flow in 29 of the 35 cases. A notable decrease in cellulitis incidence was observed. Additionally, the occurrence of cellulitis decreased significantly, except for DLNF (Stage Ⅱ). The median follow-up time was 16 months (range, 12-36 months), with no reported severe postoperative complications.
For advanced GC-LEL, SLNF combined with liposuction is a preferred treatment, offering fewer complications, shorter operative time, and hospitalization.
妇科癌症相关下肢淋巴水肿（GC-LEL）是一种慢性、进行性疾病，缺乏标准化治疗方法。目前，锁骨上血管化淋巴结转移（SC-VLNT）是治疗淋巴水肿的首选方法，并且有联合技术的趋势。本研究对同时行 SC-VLNT 和吸脂术治疗 GC-LEL 的三种技术进行了对比分析。
对 35 例 GC-LEL 患者进行了研究，其中 13 例行带皮岛的单个淋巴结皮瓣（SLNF+P），12 例行不带皮岛的单个淋巴结皮瓣（SLNF），10 例行不带皮岛的双淋巴结皮瓣（DLNF）。详细记录了患者的人口统计学和结局数据，包括围手术期变量。
在 II 期，SLNF+P、SLNF 和 DLNF 组的肢体体积减少中位数分别为 56.4%、60.8%和 50.5%，在 III 期，分别为 54.0%、59.8%和 54.4%。DLNF 组的皮瓣采集和移植时间较长。SLNF+P 组的平均术后住院时间为 8 天，长于其他两组。所有患者的淋巴水肿生活质量评分均有主观改善，35 例中有 29 例淋巴闪烁显像显示淋巴液流动增强。蜂窝织炎的发生率显著降低。此外，除 DLNF（II 期）外，蜂窝织炎的发生率显著降低。中位随访时间为 16 个月（范围 12-36 个月），无严重术后并发症报告。
对于晚期 GC-LEL，SLNF 联合吸脂术是一种首选的治疗方法，并发症少，手术时间和住院时间短。
