Wong Allen Wei-Jiat, Sim Nadia Hui Shan, Thing Coeway Boulder, Xu Wenxuan, Chua Hui Wen, Ngaserin Sabrina, Loh Shermaine, Kok Yee Onn, Feng Jia Jun, Pearlie Tan Woon Woon, Tan Benita Kiat-Tee
Plastic, Reconstructive & Aesthetic Surgery Service, Sengkang General Hospital, Singapore.
Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan.
Arch Plast Surg. 2024 Aug 6;51(5):504-509. doi: 10.1055/a-2336-0150. eCollection 2024 Sep.
The treatment of breast cancer has seen great success in the recent decade. With longer survivorship, more attention is paid to function and aesthetics as integral treatment components. However, breast cancer-related lymphedema (BCRL) remains a significant complication. Immediate lymphatic reconstruction is an emerging technique to reduce the risk of BCRL, the Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) being the most widely used approach. Despite promising results, it is often difficult to find suitably sized recipient venules and perform the microanastomoses between mismatched vessels deep in the axilla. Moreover, high axillary venous pressure gradients and potential damage from radiotherapy may affect the long-term patency of the anastomoses. From an ergonomic point of view, performing lymphaticovenular anastomosis in the deep axilla may be challenging for the microsurgeon. In response to these limitations, we modified the technique by moving the lymphatic reconstruction distally-terming it distally based LYMPHA (dLYMPHA). A total of 113 patients underwent mastectomy with axillary clearance in our institution from 2018 to 2021. Of these, 26 underwent subsequent dLYMPHA (Group 2), whereas 87 did not (Group 1). In total, 17.2% (15 patients) and 3.84% (1 patient) developed BCRL in Groups 1 and 2, respectively ( = 0.018). Lymphatics and recipient venules suitable for anastomoses can be reliably found in the distal upper limb with better size match. A distal modification achieves a more favorable lymphaticovenular pressure gradient, vessel match, and ergonomics while ensuring a comparably low BCRL rate.
在过去十年中，乳腺癌的治疗取得了巨大成功。随着患者生存期延长，功能和美观作为整体治疗的组成部分越来越受到关注。然而，乳腺癌相关淋巴水肿（BCRL）仍然是一个严重的并发症。即时淋巴重建是一种降低BCRL风险的新兴技术，淋巴显微外科预防性愈合方法（LYMPHA）是应用最广泛的方法。尽管取得了令人鼓舞的结果，但通常很难找到尺寸合适的受体小静脉，并且难以在腋窝深处进行不匹配血管之间的显微吻合。此外，高腋窝静脉压力梯度和放疗可能造成的潜在损伤可能会影响吻合口的长期通畅性。从人体工程学角度来看，在腋窝深处进行淋巴管静脉吻合对显微外科医生来说可能具有挑战性。针对这些局限性，我们对该技术进行了改良，将淋巴重建向远端移动，将其称为远端LYMPHA（dLYMPHA）。2018年至2021年，我院共有113例患者接受了乳房切除术并进行了腋窝清扫。其中，26例随后接受了dLYMPHA（第2组），而87例未接受（第1组）。第1组和第2组分别有17.2%（15例患者）和3.84%（1例患者）发生了BCRL（P = 0.018）。在远端上肢能够可靠地找到适合吻合的淋巴管和受体小静脉，且尺寸匹配更好。远端改良在确保BCRL发生率相当低的同时，实现了更有利的淋巴管静脉压力梯度、血管匹配和人体工程学。
