Hahn Brett A, Kleeven Alieske, Richir Milan C, Witkamp Arjen J, Kuijpers Anke M J, de Jong Tim, Qiu Shan, Coert J Henk, Krijgh David D
Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.
Microsurgery. 2025 Mar;45(3):e70050. doi: 10.1002/micr.70050.
Upper extremity lymphedema (UEL) and lower extremity lymphedema (LEL) can develop as a result of lymph node dissection in the treatment of various malignancies. While emerging microsurgical interventions using lymphaticovenous anastomosis (LVA) and vascularized lymph node transfer (VLNT) show promising outcomes for patients with lymphedema, the best approach to implementing the two procedures remains to be defined. This systematic review and meta-analysis provide a comprehensive overview of published literature on the clinical improvement of extremity lymphedema in patients who undergo either LVA, VLNT, or a combined microsurgical procedure.
From Embase, PubMed, and Web of Science databases, 52 studies were identified that met inclusion criteria. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The risk of bias was assessed using the Risk Of Bias In Nonrandomized Studies-of Interventions (ROBINS-I) tool and the Cochrane tool for randomized trials (RoB 2).
Random-effects meta-analyses of means estimated a pooled clinical improvement of 36.46% (95% CI: 29.44-43.48) for UEL and 34.16% (95% CI: 23.93-44.40) for LEL. Subgroup analyses revealed differences in clinical improvement according to the microsurgical approach. Clinical improvement of UEL was 29.44% (95% CI: 15.58-43.29) for LVA, 41.66% (95% CI: 34.13-49.20) for VLNT, and 32.80% (95% CI: 21.96-43.64) for combined VLNT + LVA, while the improvement of LEL was 31.87% (95% CI: 18.60-45.14) for LVA and 39.53% (95% CI: 19.37-59.69) for VLNT.
The findings from this study elucidate the clinical improvement in extremity lymphedema from various microsurgical approaches. This knowledge could aid physicians in the shared decision-making process with UEL and LEL patients and better facilitate proper patient selection for microsurgical interventions.
上肢淋巴水肿（UEL）和下肢淋巴水肿（LEL）可在各种恶性肿瘤治疗中的淋巴结清扫术后发生。虽然新兴的采用淋巴管静脉吻合术（LVA）和带血管蒂淋巴结转移术（VLNT）的显微外科干预对淋巴水肿患者显示出有前景的疗效，但实施这两种手术的最佳方法仍有待确定。本系统评价和荟萃分析全面概述了已发表的关于接受LVA、VLNT或联合显微外科手术的患者肢体淋巴水肿临床改善情况的文献。
从Embase、PubMed和Web of Science数据库中，识别出52项符合纳入标准的研究。本评价按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行。使用非随机干预研究中的偏倚风险（ROBINS-I）工具和Cochrane随机试验工具（RoB 2）评估偏倚风险。
对均值的随机效应荟萃分析估计，UEL的合并临床改善率为36.46%（95%CI：29.44 - 43.48），LEL为34.16%（95%CI：23.93 - 44.40）。亚组分析揭示了根据显微外科手术方法的临床改善差异。LVA治疗UEL的临床改善率为29.44%（95%CI：15.58 - 43.29），VLNT为41.66%（95%CI：34.13 - 49.20），联合VLNT + LVA为32.80%（95%CI：21.96 - 43.64），而LVA治疗LEL的改善率为31.87%（95%CI：18.60 - 45.14），VLNT为39.53%（95%CI：19.37 - 59.69）。
本研究结果阐明了各种显微外科手术方法对肢体淋巴水肿的临床改善情况。这些知识有助于医生在与UEL和LEL患者的共同决策过程中，并更好地促进对显微外科干预的合适患者选择。
