■最近下肢淋巴水肿患者数量的增加以及显微外科技术的发展导致了淋巴水肿治疗的增加。血管化网膜淋巴结转移(VOLT),一种新兴的四肢淋巴水肿治疗方式,在重建淋巴循环和吸收渗出的淋巴液方面显示了其独特的优势。接受或不接受放射治疗的根治性肿瘤切除术的患者通常表现为腹股沟淋巴结受损或变性。对于这种情况,VOLT可以提供足够的淋巴结和组织来吸收这些区域的水肿液。因此,在这项研究中,我们分析了在磁共振淋巴管造影(MRL)指导下VOLT的手术结果,因为这种个性化和精确的外科手术可以使患者受益并改善他们的生活质量。
■从2021年11月到2022年9月,共有14名患有四肢淋巴水肿的19条腿的患者接受了有或没有淋巴静脉吻合术(LVA)的VOLT。结果,包括周长减少率,术前和术后MRL结果,和其他并发症,进行了分析。
■平均随访期为8.86±1.41个月(范围,7-11个月)。不同平面的平均围缩率{围缩率(%)=[1-(术后患肢-健康肢)/(术前患肢-健康肢)]×100%}(即,脚踝,膝盖以上10厘米,膝盖以下10厘米,脚踝上方10厘米,膝盖以上20厘米)为15.64%±40.08%,11.79%±30.69%,20.25%±24.94%,7.73%±30.05%,-1.517%±16.75%。值得注意的是,一名患者患有多重耐药革兰阴性感染,这导致了三个皮瓣的损失。其余13例术后MRL表现为淋巴引流和下肢容积改善。
■使用VOLT通过MRL对腹股沟淋巴结和下肢淋巴系统进行精确评估,可以为外科医生提供全面的了解和可靠的证据,以治疗与癌症相关的下肢淋巴水肿。
UNASSIGNED: The recent increase in the number of patients with lower extremities lymphedema and the development of microsurgery techniques have led to a rise in lymphedema treatment. Vascularized omental lymph node transfer (VOLT), an emerging treatment modality for extremity lymphedema, has shown its unique advantages in reconstructing lymphatic circulation and absorbing exudated lymphatic fluid. Patients who underwent radical tumor resection with/without radiation therapy treatment often present with impairment or degeneration of the inguinal lymph nodes. For such cases, VOLT could provide adequate lymph nodes and tissue to absorb edema fluid in these areas. Therefore, we analyzed the operative outcomes of VOLT under the guidance of magnetic resonance lymphangiography (MRL) in this study, as this individualized and precise surgical procedure could benefit patients and improve their quality of life.
UNASSIGNED: From November 2021 to September 2022, a total of 14 patients\' 19 legs with extremity lymphedema underwent a VOLT with or without lymphaticovenous anastomosis (LVA). Outcomes, including circumference reduction rates, preoperative and postoperative MRL results, and other complications, were analyzed.
UNASSIGNED: The mean follow-up period was 8.86±1.41 months (range, 7-11 months). The mean circumference reduction rates {circumference reduction rate (%) = [1 - (postoperative affected limb - healthy limb)/(preoperative affected limb - healthy limb)] × 100%} of different planes (i.e., ankle, 10 cm above the knee, 10 cm below the knee, 10 cm above the ankle, and 20 cm above the knee) were 15.64%±40.08%, 11.79%±30.69%, 20.25%±24.94%, 7.73%±30.05%, -1.517%±16.75%. Notably, one patient had multi-drug-resistant gram-negative infections, which resulted in the loss of three flaps. The postoperative MRL showed improved lymphatic drainage and lower extremity volume in the remaining 13 cases.
UNASSIGNED: The precision evaluation of inguinal lymph nodes and lower extremities lymphatic system through MRL using VOLT can provide surgeons with a comprehensive understanding and reliable evidence for the treatment of cancer-related lower extremity lymphedema.