Chang Chad, Kuo Pao-Jen, Wang Yu-Ming, Wu Shao-Chun, Lin Wei-Che, Chien Peng-Chen, Hsieh Ching-Hua, Yang Johnson Chia-Shen
Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
Department of Surgery, Lymphedema Center, Divsion of Plastic and Reconstructive Surgery Chang Gung Memorial Hospital Kaohsiung, Kaohsiung, Taiwan.
Int J Surg. 2025 Jun 20. doi: 10.1097/JS9.0000000000002785.
Based on the recent advancement in the concepts of lymphosome and the use of antegrade lymph flow, shifting lymphaticovenous anastomosis (LVA) more proximally to the groin region for lower extremity lymphedema (LEL) offers theoretical advantages, but its efficacy compared to conventional distal LVA remains underexplored.
This prospective cohort study compared 45 patients who underwent groin-only LVA (study group) with 144 patients who underwent non-groin LVA (control group), matched using propensity score analysis. Patients with a history of previous LVA, liposuction, or excisional therapy were excluded. Patient characteristics, intraoperative findings, functional parameters, and pre- and post-LVA volume changes were recorded and matched. The primary endpoint was the volume reduction at 6 and 12 months post-LVA.
After matching, 29 patients were included in each group. The study group demonstrated significantly fewer incisions, fewer recipient veins, and less venous-lymphatic reflux but required deeper dissection compared to the control group (P < 0.001, < 0.001, = 0.014, < 0.001, respectively). At the 6- and 12-month follow-up, the study group showed a statistically significantly greater reduction in lower leg volume compared to the control group (P = 0.011 and 0.029, respectively). While not statistically significant, the study group also demonstrated greater volume reduction in the overall lower limb and thigh at both time points.
These findings suggest that groin-only LVA may be a more effective approach for treating LEL, potentially offering benefits like simplified surgical planning, improved efficiency, and a less invasive approach.
基于淋巴小体概念的最新进展以及顺行淋巴流的应用，将下肢淋巴水肿（LEL）的淋巴管静脉吻合术（LVA）向腹股沟区更靠近近端转移具有理论优势，但与传统的远端LVA相比，其疗效仍未得到充分探索。
这项前瞻性队列研究将45例行单纯腹股沟LVA的患者（研究组）与144例行非腹股沟LVA的患者（对照组）进行比较，采用倾向评分分析进行匹配。排除既往有LVA、抽脂或切除治疗史的患者。记录并匹配患者特征、术中发现、功能参数以及LVA前后的体积变化。主要终点是LVA后6个月和12个月时的体积减少情况。
匹配后，每组纳入29例患者。与对照组相比，研究组的切口明显更少（P<0.001）、受体静脉更少（P<0.001）、静脉淋巴反流更少（P=0.014），但需要更深入的解剖（P<0.001）。在6个月和12个月的随访中，研究组小腿体积的减少在统计学上显著大于对照组（分别为P=0.011和0.029）。虽然无统计学意义，但研究组在两个时间点下肢总体积和大腿体积的减少也更大。
这些发现表明，单纯腹股沟LVA可能是治疗LEL的一种更有效方法，可能具有简化手术规划、提高效率和侵入性较小等优点。
