在资源匮乏地区针对乳腺癌相关淋巴水肿的超显微淋巴管静脉吻合术
Supermicrosurgical lymphaticovenous anastomosis for breast cancer related lymphedema in low resources settings.
作者信息
Hashem Tarek, Yamamoto Takumi
机构信息
Breast Unit-Surgical Oncology Department, National Cancer Institute, Cairo University, Giza, Egypt.
Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.
出版信息
World J Surg Oncol. 2025 Apr 24;23(1):156. doi: 10.1186/s12957-025-03756-8.
BACKGROUND
Supermicrosurgical lymphaticovenous anastomosis (LVA)is becoming popular for the management of breast cancer-related lymphedema (BCRL), but mainly provided in well-developed countries. Little is known on possibility of LVA with limited resources. This study aimed to evaluate feasibility of LVA in Egypt, where latest devices are not available.
METHODS
Medical records of patients who underwent LVA for progressive BCRL were reviewed. All patients were refractory to conservative treatment for 6 months or longer. As devices for near-infrared fluorescent lymphography was not available, a conventional high-frequency (18-MHz) ultrasound was used to localize the lymph vessels and veins for LVA. LVA was done using conventional microsurgery sets and 10 - 0 nylon sutures under an operating microscope with 40 times magnification. One-year postoperative results were evaluated based on upper extremity lymphedema index (UEL index), cellulitis frequency, and subjective symptoms.
RESULTS
Twenty-three patients were included. The number of LVAs per limb ranged from 2 to 3 (average, 2). Lymph vessel detection rate was 92.6% (50/54). Ten (43.5%) patients with dermal backflow (DB) showed 19.2% postoperative volume reduction based on UEL index after one year. Thirteen (56.5%) patients without dermal backflow showed only 2% reduction. Postoperative UEL index was significantly lower than preoperative UEL index (123.5 ± 7.3 ml vs. 136.4 ± 9.4 ml, P = 0.017). Postoperative cellulitis frequency was decreased compared to preoperative one (2.15 ± 0.85 vs. 0.09 ± 0.18 attack/year, P ˂ 0.001). 13(56.5%) patients reported improvement in all subjective symptoms; limb tension improvement in 18 (78.3%) patients, limb heaviness in 15 (65.2%), and overall limb mobility in 13 (56.5%).
CONCLUSIONS
LVA could be safely and effectively performed in limited resources settings without latest device for lymphatic mapping nor supermicrosurgery instruments. A conventional high-frequency ultrasound allows lymphatic and venous mapping useful for LVA. LVA should not be given up even with limited resources.
背景
超显微外科淋巴管静脉吻合术（LVA）在乳腺癌相关淋巴水肿（BCRL）的治疗中越来越受欢迎，但主要在发达国家开展。关于在资源有限的情况下进行LVA的可能性知之甚少。本研究旨在评估在埃及开展LVA的可行性，该国没有最新的设备。
方法
回顾了因进行性BCRL接受LVA治疗的患者的病历。所有患者均对保守治疗6个月或更长时间无效。由于没有近红外荧光淋巴造影设备，使用传统的高频（18MHz）超声定位淋巴管和静脉以进行LVA。在40倍放大的手术显微镜下，使用传统的显微手术器械和10-0尼龙缝线进行LVA。根据上肢淋巴水肿指数（UEL指数）、蜂窝织炎发生率和主观症状评估术后一年的结果。
结果
纳入23例患者。每只肢体的LVA数量为2至3次（平均2次）。淋巴管检出率为92.6%（50/54）。10例（43.5%）有皮肤反流（DB）的患者术后一年基于UEL指数的体积减少了19.2%。13例（56.5%）无皮肤反流的患者仅减少了2%。术后UEL指数显著低于术前UEL指数（123.5±7.3ml对136.4±9.4ml，P=0.017）。术后蜂窝织炎发生率较术前降低（2.15±0.85对0.09±0.18次/年，P＜0.001）。13例（56.5%）患者报告所有主观症状均有改善；18例（78.3%）患者肢体张力改善，15例（65.2%）患者肢体沉重感改善，13例（56.5%）患者肢体整体活动度改善。
结论
在没有用于淋巴绘图的最新设备和超显微手术器械的资源有限的情况下，LVA可以安全有效地进行。传统的高频超声可用于LVA的淋巴管和静脉绘图。即使资源有限，也不应放弃LVA。
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