乳腺癌相关淋巴水肿淋巴显像分期与脂肪抽吸术联合淋巴管-静脉吻合术疗效的相关性

Correlation between lymphoscintigraphy stage of breast cancer-related lymphedema and therapeutic effect of liposuction combined with lymphatic-venous anastomosis

目的观察乳腺癌相关淋巴水肿(BCRL)治疗前淋巴显像分期与脂肪抽吸术联合淋巴管-静脉吻合术(LVA)疗效的相关性。方法回顾性分析67例接受脂肪抽吸术并于术后3个月接受LVA的BCRL患者,依据治疗前淋巴显像分为患侧上肢淋巴部分梗阻(P期)与完全梗阻(T期)组;记录联合治疗后3及6个月双上肢淋巴水肿指数(UELi)、患侧UELi超额百分比(UPE)、治疗后与治疗前患侧UPE比值(rUPE)及术后上肢淋巴水肿功能、残疾与健康问卷调查表(Lymph-ICF-UL)评分,对比不同分期患者治疗后临床参数及上肢淋巴水肿改善情况。结果治疗前淋巴显像显示P期组29例、T期组38例。组间治疗前蜂窝织炎发生率、术中吸出脂肪体积差异均有统计学意义(P均<0.05)。联合治疗后3及6个月,67例患侧UELi、UPE及Lymph-ICF-UL评分均低于治疗前,差异均有统计学意义(P均<0.05)。结论BCRL治疗前淋巴显像分期与脂肪抽吸术联合LVA疗效相关。

Objective To explore the correlation between lymphoscintigraphy stage of breast cancer-related lymphedema(BCRL)before treatments and the therapeutic effect of liposuction combined with lymphatic-venous anastomosis(LVA).Methods Data of 67 BCRL patients who received liposuction combined with LVA 3 months later were retrospectively analyzed.The patients were divided into partial(P-stage)and total obstruction(T-stage)groups according to lymphoscintigraphic findings of the affected upper limb lymphatic before treatments.Bilateral upper limb lymphedema index(UELi),the percentage of excess UELi(UPE)of the affected limb lymphedema,the ratio of before treatments UPE to post treatments UPE(rUPE)of the affected limb,as well as the lymphedema functioning,disability and health questionnaire for the affected upper limb lymphedema(Lymph-ICF-UL)score 3 and 6 months after treatments were recorded.The clinical parameters and improvements of the affected upper limb lymphedema were compared between groups.Results Lymphoscintigraphy before treatment showed 29 cases in P-stage group and 38 cases in T-stage group.Significant differences of the incidence of cellulitis before treatments and volume of fat particles extracted were found between groups(both P<0.05).Three and 6 months after treatments,UELi and UPE of the affected limb and Lymph-ICF-UL scores of all 67 patients were lower than those before treatments(all P<0.05).Conclusion Lymphoscintigraphy stage of BCRL before treatments was correlated with therapeutic effect of liposuction combined with LVA.