关键词: Combination therapy Liposuction Lower extremity Lymphedema Vascularized lymph node

来  源:   DOI:10.1016/j.jvsv.2024.101905

Abstract:
OBJECTIVE: Gynecological cancer-related lower extremity lymphedema (GC-LEL), a chronic, progressive condition, lacks a standardized treatment. Currently, supraclavicular vascularized lymph node transfer (SC-VLNT) is a favored approach in the treatment of lymphedema, and there is a trend toward combination technology. This study conducts a comparative analysis of three techniques for treating GC-LEL with simultaneous SC-VLNT and liposuction.
METHODS: A cohort of 35 patients with GC-LEL was examined, comprising 13 patients who underwent single lymph nodes flap with a skin paddle (SLNF+P), 12 who received single lymph nodes flap without a skin paddle (SLNF), and 10 who accepted dual lymph nodes flap without a skin paddle (DLNF). Patient demographics and outcomes were meticulously documented, covering intra- and postoperative variables.
RESULTS: The median limb volume reduction were 56.4% (SLNF+P), 60.8% (SLNF), and 50.5% (DLNF) in stage II, and 54.0% (SLNF+P), 59.8% (SLNF), and 54.4% (DLNF) in stage III. DLNF group procedures entailed longer flap harvesting and transplantation times. The SLNF+P group, on average, had an 8-day postoperative hospitalization, longer than others. All patients noted subjective improvements in Lymphedema Quality of Life scores, with lymphoscintigraphy revealing enhanced lymphatic flow in 29 of the 35 cases. A notable decrease in cellulitis incidence was observed. Additionally, the occurrence of cellulitis decreased significantly, except for DLNF (Stage Ⅱ). The median follow-up time was 16 months (range, 12-36 months), with no reported severe postoperative complications.
CONCLUSIONS: For advanced GC-LEL, SLNF combined with liposuction is a preferred treatment, offering fewer complications, shorter operative time, and hospitalization.
摘要:
目的:妇科肿瘤相关下肢淋巴水肿(GC-LEL),一个慢性的,渐进条件,缺乏标准化治疗。目前,锁骨上血管化淋巴结转移(SC-VLNT)是治疗淋巴水肿的首选方法,有一种趋势是组合技术。本研究对同时使用SC-VLNT和吸脂术治疗GC-LEL的三种技术进行了比较分析。
方法:对35例GC-LEL患者进行了检查,包括13例患者接受了带有皮桨的单淋巴结皮瓣(SLNFP),12个接受单淋巴结瓣,没有皮肤桨(SLNF),和十个接受的无皮肤桨(DLNF)的双淋巴结瓣。患者的人口统计学和结果被精心记录,涵盖术中和术后变量。
结果:肢体体积减少中位数为56.4%(SLNFP),60.8%(SLNF),第二阶段为50.5%(DLNF),和54.0%(SLNF+P),59.8%(SLNF),第三阶段为54.4%(DLNF)。DLNF组程序需要更长的皮瓣收获和移植时间。SLNF+P组,平均而言,术后住院8天,比别人长。所有患者均注意到淋巴水肿生活质量(LYMQOL)评分的主观改善,淋巴闪烁显像显示35例中有29例淋巴流量增强。观察到蜂窝织炎发生率显着下降。此外,蜂窝织炎的发生率明显下降,DLNF(Ⅱ期)除外。中位随访时间为16个月(范围,12至36个月),没有报告严重的术后并发症。
结论:对于高级GC-LEL,SLNF联合吸脂术是首选治疗方法,提供更少的并发症,手术时间更短,和住院。
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