基于MRI淋巴管造影分型的淋巴管静脉吻合术治疗下肢淋巴水肿的疗效评估  

Evaluation of the efficacy of lymphatic venous anastomosis in the treatment of lower limb lymphedema based on MRI lymphangiography classification

作　　者：汪京京 张敏鸽 谢继承 杨海 易利奇 季文斌 WANG Jingjing;ZHANG Minge;XIE Jicheng;YANG Hai;YI Liqi;JI Wenbin(Department of Radiology,Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University,Taizhou,Zhejiang Province 318050,China;Department of Radiology,Enze Hospital,Taizhou Enze Medical Center(Group),Taizhou,Zhejiang Province 318050,China;Department of Hand and Foot Surgery,Enze Hospital,Taizhou Enze Medical Center(Group),Taizhou,Zhejiang Province 318050,China)

机构地区：[1]温州医科大学附属台州医院放射科,浙江台州318050 [2]台州恩泽医疗中心(集团)恩泽医院放射科,浙江台州318050 [3]台州恩泽医疗中心(集团)恩泽医院手足外科,浙江台州318050

出　　处：《实用放射学杂志》2024年第11期1871-1874,1879,共5页Journal of Practical Radiology

基　　金：台州市科技计划项目(23ywa43)。

摘　　要：目的探讨基于MRI淋巴管造影分型的淋巴管静脉吻合术对下肢淋巴水肿的治疗疗效,并分析淋巴管静脉吻合术治疗疗效的影响因素。方法选取378例继发下肢淋巴水肿患者,均行MRI淋巴管造影检查。比较不同类型患者淋巴管静脉吻合术前及术后双下肢周径差值及并发症发生率;在随访6个月后根据国际淋巴学会淋巴水肿分级标准评价治疗疗效,分析影响淋巴管静脉吻合术治疗疗效的危险因素,并建立预测模型,分析该模型对淋巴管静脉吻合术临床疗效的评估价值。结果不同分型患者治疗有效率及术后并发症发生率对比差异无统计学意义(P>0.05)。3型、4型、5型、6型治疗前后双下肢周径差值大于1型、2型、7型(P<0.05)。年龄过大、合并感染及淋巴结静脉瘘是淋巴管静脉吻合术临床疗效的影响因素(P<0.05)。经logistic回归分析得到淋巴管静脉吻合术临床疗效的风险预测模型,P=1/[1+e^((0.531X_(年龄)+0.722X_(合并感染)+0.807X_(淋巴结静脉瘘)-1.249))],Hosmer-Lemeshow检验显示,预测模型与标准曲线的拟合度χ^(2)=2.190,P=0.975。预测模型对淋巴管静脉吻合术临床疗效的曲线下面积(AUC)0.985,标准误(S.E)值为0.009,95%置信区间(CI)0.967~1.000。结论基于MRI淋巴管造影分型的淋巴管静脉吻合术治疗下肢淋巴水肿的临床疗效较好、并发症少,基于危险因素分析建立的预测模型,对淋巴管静脉吻合术临床疗效具有较高的预测价值。Objective To explore the therapeutic effect of lymphatic venous anastomosis based on MRI lymphangiography classification on lower limb lymphedema,and to analyze the factors affecting the therapeutic effect of lymphatic venous anastomosis.Methods A total of 378 patients with secondary lymphedema of lower limbs were selected.All of them underwent MRI lymphangiography.The difference of circumference diameter and complication rate of the lower limbs of different types of patients before and after lymphatic venous anastomosis were compared.After 6 months of follow-up,the therapeutic effect was evaluated according to the International Lymphology Society classification standards for lymphedema.The risk factors affecting the therapeutic effect of lymphatic venous anastomosis was analyzed,and a prediction model was established to analyze the value of this model in evaluating the clinical efficacy of lymphatic venous anastomosis.Results There was no significant difference in treatment efficiency and postoperative complication rate among different types of patients(P>0.05).The difference of circumference diameter of the lower limbs of type 3,type 4,type 5 and type 6 before and after treatment was greater than that of type 1,type 2 and type 7(P<0.05).Age,concomitant infection and lymph node venous fistula were the factors affecting the clinical efficacy of lymphatic venous anastomosis(P<0.05).The risk prediction model for the clinical efficacy of lymphatic venous anastomosis was developed through logistic regression analysis:P=1/[1+e^((0.531Xage+0.722Xconcomitant infection+0.807Xlymph node venous fistula-1.249))].The Hosmer-Lemeshow test indicated that the fitted model matched the standard curve with χ^(2)=2.190,P=0.975.The area under the curve(AUC)of the prediction model for the clinical efficacy of lymphatic venous anastomosis was 0.985,with a standard error(S.E)value of 0.009 and a 95%confidence interval(CI)of 0.967 to 1.000.Conclusion Lymphatic venous anastomosis based on MRI lymphangiography classification has better c

关 键 词：淋巴管造影分型 淋巴管静脉吻合术 下肢淋巴水肿 治疗疗效 影响因素 

分 类 号：R445.2[医药卫生—影像医学与核医学] R551.2[医药卫生—诊断学]