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显微外科淋巴管移植治疗慢性淋巴水肿:体积缩小和淋巴转运动力学的长期评估

Microsurgical Lymphatic Vessel Transplantation for Chronic Lymphedema: Long-Term Evaluation of Volume Reduction and Lymphatic Transport Kinetics.

作者信息

Demmer Wolfram, Hock Louisa Antonie, Koban Konstantin Christoph, Wiggenhauser Paul Severin, Brendel Matthias, Giunta Riccardo, Nürnberger Tim

机构信息

Department of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, 80539 Munich, Germany.

Department of Nuclear Medicine, Ludwig-Maximilians-University, 81377 Munich, Germany.

出版信息

Life (Basel). 2025 Jun 4;15(6):914. doi: 10.3390/life15060914.

DOI:10.3390/life15060914
PMID:40566566
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12193778/
Abstract

This study investigates long-term volume reduction after microsurgical autologous lymphatic vessel transplantation (LVT) in patients with chronic lymphoedema. Lymphoedema is caused by inadequate lymphatic drainage and leads to swelling, pain, and a reduced quality of life. Conservative treatments often show only limited success, which is why surgical procedures such as LVT are increasingly gaining in importance. In a retrospective long-term analysis, patients who underwent LVT between 1988 and 2010 were examined on average 21.7 years after surgery. The examination included pre- and post-operative volume measurements, which were supplemented by modern 3D body scanner analyses and lymphoscintigraphy. The results show a significant volume reduction both in the short term ( < 0.01) and at the follow-up examination ( = 0.04). There was no significant difference between manual volumetry with circumferential measurements and 3D volumetry ( = 0.775). The improvement in lymph transport capacity was considerable ( = 0.078). This study provides valuable insights for the further development of lymphatic surgery. While preferred surgical methods change over time, this study demonstrates that LVT can make a decisive contribution to improving the quality of life of lymphedema patients.

摘要

本研究调查了慢性淋巴水肿患者接受显微外科自体淋巴管移植(LVT)后的长期体积减小情况。淋巴水肿是由淋巴引流不足引起的,会导致肿胀、疼痛和生活质量下降。保守治疗往往效果有限,这就是为什么诸如LVT等外科手术越来越重要的原因。在一项回顾性长期分析中,对1988年至2010年间接受LVT的患者在术后平均21.7年进行了检查。检查包括术前和术后的体积测量,并辅以现代3D身体扫描仪分析和淋巴闪烁造影。结果显示,短期内(<0.01)和随访检查时(=0.04)体积均有显著减小。周向测量的手动容积法与3D容积法之间无显著差异(=0.775)。淋巴运输能力有相当大的改善(=0.078)。本研究为淋巴外科的进一步发展提供了有价值的见解。虽然首选的手术方法会随时间变化,但本研究表明LVT可为改善淋巴水肿患者的生活质量做出决定性贡献。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/238f/12193778/13a885e1f0e4/life-15-00914-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/238f/12193778/e5d3f29cf7e9/life-15-00914-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/238f/12193778/78a997cbde17/life-15-00914-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/238f/12193778/dbf516eb11bd/life-15-00914-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/238f/12193778/36188e3a1706/life-15-00914-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/238f/12193778/d47f6a56b410/life-15-00914-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/238f/12193778/13a885e1f0e4/life-15-00914-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/238f/12193778/e5d3f29cf7e9/life-15-00914-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/238f/12193778/78a997cbde17/life-15-00914-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/238f/12193778/dbf516eb11bd/life-15-00914-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/238f/12193778/36188e3a1706/life-15-00914-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/238f/12193778/d47f6a56b410/life-15-00914-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/238f/12193778/13a885e1f0e4/life-15-00914-g007.jpg

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本文引用的文献

1
Advances in surgical management of chronic lymphedema: current strategies and future directions.慢性淋巴水肿外科治疗进展:当前策略与未来方向
Med Oncol. 2025 Jan 13;42(2):44. doi: 10.1007/s12032-024-02576-2.
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Quality of Life in Lymphedema Patients Treated by Microsurgical Lymphatic Vessel Transplantation-A Long-Term Follow-Up.显微外科淋巴管移植治疗淋巴水肿患者的生活质量——长期随访
Life (Basel). 2024 Jul 30;14(8):957. doi: 10.3390/life14080957.
3
Limb Volume Measurements: A Comparison of Circumferential Techniques and Optoelectronic Systems against Water Displacement.
肢体体积测量:圆周测量技术和光电系统与水置换法的比较
Bioengineering (Basel). 2024 Apr 15;11(4):382. doi: 10.3390/bioengineering11040382.
4
Digital Volumetric Measurements Based on 3D Scans of the Lower Limb: A Valid and Reproducible Method for Evaluation in Lymphedema Therapy.基于下肢 3D 扫描的数字容积测量:一种评估淋巴水肿治疗的有效且可重复的方法。
Ann Vasc Surg. 2024 Aug;105:209-217. doi: 10.1016/j.avsg.2024.01.011. Epub 2024 Apr 3.
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Manual lymphatic drainage: the evidence behind the efficacy.手动淋巴引流:疗效背后的证据。
Br J Community Nurs. 2024 Feb 2;29(2):83-84. doi: 10.12968/bjcn.2024.29.2.83.
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The emerging importance of lymphatics in health and disease: an NIH workshop report.淋巴管在健康和疾病中的新兴重要性:NIH 研讨会报告。
J Clin Invest. 2023 Sep 1;133(17):e171582. doi: 10.1172/JCI171582.
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Breast Cancer. 2023 Mar;30(2):187-199. doi: 10.1007/s12282-022-01428-z. Epub 2022 Dec 26.
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[Diagnosis of leg edema].[腿部水肿的诊断]
Dermatologie (Heidelb). 2023 Mar;74(3):182-189. doi: 10.1007/s00105-022-05082-6. Epub 2022 Dec 9.
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