基于淋巴显像评估联合手术治疗妇科恶性肿瘤术后下肢淋巴水肿的疗效预测  

Predicting therapeutic efficacy of combined surgery for gynecological cancer-related lower limb lymphedema based on lymphoscintigraphy evaluation

作　　者：蔺楠 任超 童冠圣 文哲 LIN Nan;REN Chao;TONG Guan-sheng;WEN Zhe(Department of Nuclear Medicine,Bejing Shijitan Hospital,Capital Medical University,Beijing 100038,China;Department of Nuclear Medicine,Peking Union Medical College Hospital,Chinese Academy of Medical of Medical Science/Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine,Bejing 100730,China)

机构地区：[1]首都医科大学附属北京世纪坛医院核医学科,北京100038 [2]中国医学科学院北京协和医院核医学科,核医学分子靶向诊疗北京市重点实验室,北京100730

出　　处：《中国临床医学影像杂志》2025年第1期46-50,共5页Journal of China Clinic Medical Imaging

基　　金：首都卫生发展科研专项项目(编号:首发2024-2-2085)。

摘　　要：目的:探讨术前淋巴显像在预测妇科恶性肿瘤术后下肢淋巴水肿患者进行联合手术治疗效果中的作用。方法:回顾性分析2021年9月—2023年3月妇科肿瘤术后下肢淋巴水肿患者行联合手术治疗175例。收集人口学信息和相关临床参数。测量术前、术后3月和6月下肢淋巴水肿指数(LELi),使用淋巴显像台湾分期系统进行评级,分析术前淋巴显像分期与下肢淋巴水肿改善的相关性。采用残疾与健康分类(LY-ICF-LL)和生活质量问卷(SF-36)评分系统评价所有患者手术后功能障碍和生活质量。最后收集患者并发症情况,分析淋巴显像分期与术后并发症关联。结果:患者术后3月和6月LELi值较术前明显下降(P<0.001),且P1~P3分期患者的术后LELi改善率(LC)变化率较为显著(P<0.05)。术后ICF评分下降,生活质量明显提高(P<0.05)。分期T4~T6的患者术后并发症发生率显著高于P1~P3的患者(P<0.05)。结论:淋巴显像可作为预测妇科恶性肿瘤术后下肢淋巴水肿进行联合手术疗效和风险的有效工具,为手术决策提供重要参考。未来需深入研究不同显像剂淋巴显像在指导妇科恶性肿瘤引起的淋巴水肿患者治疗中的差异。Objective:To explore the role of preoperative lymphoscintigraphy in predicting the effectiveness of combined surgical treatment for lower limb lymphedema(LLL)in patients with gynecological malignant tumors after surgery.Methods:A retrospective analysis was conducted on 175 patients with LLL who underwent combined surgical treatment for gynecological tumors from September 2021 to March 2023.The demographic data and relevant clinical parameters from all patients were collected.The lower extremity lymphedema index(LELi)was measured and the Taiwan lymphoscintigraphy staging system was used for grading and to analyze the correlation between preoperative lymphoscintigraphy stage and recovery of LLL.The LYICF-LL and SF-36 scoring systems were applied to evaluate postoperative functional impairment and the quality of life in all patients.Finally,the patient's complications were collected,and the correlation between lymphoscintigraphy staging and postoperative complications was analyzed.Results:The postoperative LELi values at 3 and 6 months were significantly lower than preoperative LELi values(P<0.001),and the postoperative LC change rate with stage P1~P3 was more significant(P<0.05).The postoperative ICF score decreased,and the quality of life significantly improved(P<0.05).The incidence of postoperative complications in patients with stage T4~T6 was significantly higher than that in patients with stage P1~P3(P<0.05).Conclusion:Lymphoscintigraphy can serve as an effective tool for predicting the efficacy and risk of combined surgical treatment for LLL after gynecological tumor surgery,providing important reference for surgical decision-making.In the future,it is necessary to study on the difference of lymphoscintigraphy with various radioactive tracer in guiding the treatment of gynecological cancer-related LLL.

关 键 词：淋巴水肿 下肢 放射性核素淋巴显像 

分 类 号：R551.2[医药卫生—血液循环系统疾病] R817.4[医药卫生—内科学]