基于血管化淋巴结移植的淋巴水肿外科联合治疗研究进展  

Research progress of combined surgical treatment of lymphedema based on vascularized lymph node transfer

作　　者：简扬 邓呈亮 魏在荣 JIAN Yang;DENG Chengliang;WEI Zairong(Department of Breast Surgery,Clinical Center for Breast,West China Hospital,Sichuan University,Zunyi Guizhou,563003,P.R.China)

机构地区：[1]遵义医科大学附属医院烧伤整形外科,贵州遵义563003

出　　处：《中国修复重建外科杂志》2023年第2期240-246,共7页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：省部共建协同创新中心项目[教科技厅函(2020)39号];贵州省创面外科整合治疗科技创新人才团队项目[科合平台人才(2020)5012];创面精准修复创新人才平台载体建设项目[遵市科人平台(2021)3号]。

摘　　要：目的 总结基于血管化淋巴结移植(vascularized lymph node transfer,VLNT)的淋巴水肿外科联合治疗的研究进展。方法 广泛查阅近年有关VLNT的文献,就其历史、治疗机制及临床应用进行总结,重点分析VLNT联合其他外科方法的研究进展。结果 VLNT是一种恢复淋巴引流的生理性手术,临床已开发了多个淋巴结供区,有两种假说解释其治疗淋巴水肿的机制,但存在起效慢、肢体体积减小率通常低于60%等不足。为解决这些问题,VLNT联合其他外科方法治疗淋巴水肿已成为一种趋势,包括与淋巴管-静脉吻合术、抽脂、切除术、乳房重建以及植入组织工程材料等方法联合,已被证实能有效减小患肢体积、减少蜂窝织炎发生次数和改善患者生活质量。结论 目前研究表明VLNT与减容手术、乳房重建、淋巴管-静脉吻合术、组织工程材料等方法联合使用安全可行,但需解决两次手术实施先后顺序、间隔时间等问题,有待设计严格的标准化临床研究来证实VLNT单独或联合应用的治疗效果,并进一步解决联合治疗过程中存在的问题。Objective To summarize the research progress of combined surgical treatment of lymphedema based on vascularized lymph node transfer(VLNT), and to provide systematic information for combined surgical treatment of lymphedema. Methods Literature on VLNT in recent years was extensively reviewed, and the history,treatment mechanism, and clinical application of VLNT were summarized, with emphasis on the research progress of VLNT combined with other surgical methods. Results VLNT is a physiological operation to restore lymphatic drainage. Multiple lymph node donor sites have been developed clinically, and two hypotheses have been proposed to explain its mechanism for the treatment of lymphedema. But it has some inadequacies such as slow effect and limb volume reduction rate less than 60%. To address these inadequacies, VLNT combined with other surgical methods for lymphedema has become a trend. VLNT can be used in combination with lymphovenous anastomosis(LVA),liposuction, debulking operation, breast reconstruction, and tissue engineered material, which have been shown to reduce the volume of affected limbs, reduce the incidence of cellulitis, and improve patients’ quality of life.Conclusion Current evidence shows that VLNT is safe and feasible in combination with LVA, liposuction, debulking operation, breast reconstruction, and tissue engineered material. However, many issues need to be solved, including the sequence of two surgeries, the interval between two surgeries, and the effectiveness compared with surgery alone. Rigorous standardized clinical studies need to be designed to confirm the efficacy of VLNT alone or in combination, and to further discuss the subsistent issues in the use of combination therapy.

关 键 词：血管化淋巴结移植 淋巴水肿 淋巴管-静脉吻合术 乳房重建 减容手术 

分 类 号：R551.2[医药卫生—血液循环系统疾病]