| Background:Breast cancer-related upper arm lymphedema is the most common complications after breast cancer surgery. It is a chronic, debilitating condition which can causes physical and psychological morbidity and finally influent patients’quality of life. Recently, there is no definitive treatment to cure lymphedema. In our study, we evaluated the pre-and post-operation clinical status of the patients who underwent vascular lymph node transfer (VLNT) and lymphovenous bypass (LVB), analyzed the efficiency of them, expecting to find the better methods to identify patients who can be chosen to have the vascular lymph node transfer (VLNT) and lymphovenous bypass (LVB).Objective1. To compare the clinical outcome of transplantation of lower abdominal flap with vascularized lymph nodes and lower abdominal flap only, to approve the efficiency of transplantation of lower abdominal flap with vascularized lymph node in treating breast cancer-related lymphedema.2. To compare the clinical outcome of transplantation of lower abdominal flap with vascularized lymph node plus lymphovenous bypass and transplantation of lower abdominal flap with vascularized lymph nodes, to analyze the functional mechanism of vascularized lymph node transfer and lymphovenous bypass in treating breast cancer-related lymphedema.Methods1. The study was based on the retrospective study on 26 cases of postmastectomy lymphedema during April 2008 and September 2013.26 cases were divided into 2 groups, experimental group and control group. In experimental group,13 cases underwent transplantation of lower abdominal flap with vascularized lymph node. In control group the 13 cases underwent only transplantation of lower abdominal flap. The follow-up visits were conducted 1,3,6, and 12 months after the surgery. The measurement indexes included mid-upper arm circumference, clinical symptoms, and lymphoscintigraphy.2. The study was based on the prospective study on 86 cases during December 2014 and November 2015.86 cases were divided into 2 groups, experimental group and control group. In experimental group,43 cases underwent transplantation of lower abdominal flap with vascularized lymph node plus lymphovenous bypass. In control group the 43 cases underwent only transplantation of lower abdominal flap with vascularized lymph nodes. The follow-up was conducted preoperatively and postoperatively in 1 month, 3months,6 months and 12 months by assessing the quality of life using LLIS and measuring upper limb volume.Results1. All flaps in the 26 cases worked well. One patient was found to have delayed wound healing. We compare the mid-upper arm circumference preoperatively and postoperatively in 12 month. The mean change of mid-upper arm in post 12 month in experimental group was 2.122±2.331cm, p<0.05. The mean change of mid-upper arm in post 12 month in control group was 0.423±0.465cm, p>0.05. In the lymphoscintigraphy of experimental group, we found the tracer going through the lymphatic vessel which was obstructed before operation but could not find any in cases in control group.2. We compare the upper arm volume preoperatively and postoperatively in 12 month. The mean change of upper arm volume in post 12 month in experimental group was 27.8±6.65, p<0.05. The mean change of upper arm volume in post 12 month in control group was 23.65±3.22, p＜0.05. In the compare of postoperatively volume change percentage, the percentage in experimental group was 3.94 and the control group was 4.2, p>0.05. In experimental group, the volume change tendency in preoperation,1 month,3 months,6 months,12 months were 26.8±5.28、 24.6±5.33、21.23±5.92、 25.2±4.33、22.86±3.67, respectively. The tendency was descending in first 3 months, rising in 3-6 months, and descending after 6 months. In control group, the volume change tendency in preoperation,1 month,3 months,6 months,12 months were 27.8±3.96、25.5±4.55、23.0±2.96、 25.9±6.22、23.6±5.38, respectively. The tendency was steadily descending after surgery. In the group undergoing lymphovenous bypass, the volume change pecentage in 3 months was 17.15% in end-to end cases,62.87% in end -to-side cases, and 11.87% in mixed cases, respectively. P>0.05.Conclusions1. Vascular lymph node transfer and lymphocenous bypass both can reduce the severity of upper arm lymphedema secondly to breast cancer.2. Lymphovenous bypass is more efficient in early stage lymphedema with more functional lymph vessels and less fibration.3. Indocyanine green fluorescence lymphangiography can help in identifying functioning lymphatic vessels and optimal anatomical locations to perform lymphovenous bypass.4. Indocyanine green fluorescence lymphangiography can be used to assess the severity of lymphedema and help to select patients who are best suited for lymphovenous bypass.5. Indocyanine green fluorescence lymphangiography may become a tool to subjectively evaluate the outcome of lymphedema treatment.6. LLIS can be applied to assess the quality of life in lymphedema patients. |
PDF Full Text Request