改良静脉淋巴管吻合技术治疗乳腺癌术后上肢淋巴水肿

TREATMENT OF POST- MASTECTOMY UPPER LIMB LYMPHEDEMA BY MODIFIED SIDE-TO-END LYMPHATICOVENULAR ANASTOMOSIS

目的 介绍一种改良静脉淋巴管吻合技术,评价其在治疗乳腺癌术后上肢淋巴水肿中的价值。方法 2010年5月-2011年5月,采用改良静脉淋巴管吻合技术治疗11例乳腺癌术后继发患侧上肢淋巴水肿女性患者。年龄38～55岁,平均49.5岁。乳腺癌术后7～30个月发生上肢淋巴水肿,平均18.3个月。淋巴水肿病程10～38个月,平均25.5个月。左侧上肢5例,右侧上肢6例。按照健、患侧上肢差值界定临床分型标准：中度5例,重度6例。结果 患者均顺利完成改良静脉淋巴管吻合术。术后1例前臂切口延迟愈合,其余患者切口均Ⅰ期愈合。11例患者均获随访,随访时间36～40个月,平均38.4个月。患者均自觉患肢疼痛及肿胀程度减轻,无丹毒发作,水肿得到控制。术前及术后6、36个月患侧上臂周径分别为（33.9±3.7）、（31.0±3.5）、（30.9±3.5）cm,前臂周径分别为（30.1±3.6）、（27.8±3.4）、（27.7±3.3）cm。术后6、36个月患侧上臂及前臂周径均较术前显著缩小,比较差异有统计学意义（P〈0.05）;术后6、36个月间比较,差异无统计学意义（P〉0.05）。术后36个月按照Campisi评价标准评价疗效,获优良3例,良好6例,改善2例。结论 采用改良静脉淋巴管吻合技术可有效治疗乳腺癌术后上肢淋巴水肿。

Objective To investigate the therapeutic effect of modified side-to-end lymphaticovenular anastomosis in the treatment of post-mastectomy upper limb lymphedema. Methods Between May 2010 and May 2011, 11 female patients with post-mastectomy upper limb ]ymphedema underwent a modified side-to-end lymphaticovenular anastomosis. The average age was 49.5 years （range, 38-55 years）. Lymphedema occurred at 7-30 months （mean, 18.3 months） after resection of breast cancer, with an average disease duration of 25.5 months （range, 10-38 months）. The left upper limb was involved in 5 cases and the right upper limb in 6 cases. In accordance with difference value between health and affected sides criteria, 5 cases were rated as moderate, and 6 cases as severe. Results Modified side-to-end lymphaticovenular anastomosis was successfully completed in all patients. Primary healing of incision was obtained in the other patients except 1 case of delayed healing. All patients were followed up for an average of 38.4 months （range, 36-40 months）. Limb pain and swelling were relieved; no episodic attack or recurrence was observed. The circumference of affected upper arm was significantly decreased from preoperative （33.9＋3.7） cm to postoperative （31.0＋3.5） cm at 6 months and （30.9＋3.5） cm at 36 months （P〈0.05）, but no significant difference was found between at 3 and 6 months （P〉0.05）; the circumference of affected forearm was significantly decreased from preoperative （30.1±3.6） cm to postoperative （27.8±3.4） cm at 6 months and （27.7±3.3） cm at 36 months （P〈0.05）, but no significant difference was shown between at 6 and 36 months （P〉0.05）. According to Carnpisi evaluation standard to assess efficacy, the results were excellent in 3 cases, good in 6 cases, and improved in 2 cases. Conclusion Using modified side-to-end lymphaticovenular anastomosis may be effective in the treatment of upper limb lymphedema after mastectomy.