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乳腺癌相关淋巴水肿主要由于乳腺癌治疗之后淋巴系统不畅所致。淋巴管静脉吻合术将一条或多条淋巴集合管与皮下静脉进行吻合，手术结果令人鼓舞。术后短期即可评价这些吻合的通畅性。不过，乳腺癌相关淋巴水肿患者淋巴管静脉吻合术后的长期通畅性尚不明确。 2019年9月21日，施普林格自然旗下《乳腺癌研究与治疗》在线发表荷兰马斯特里赫特大学医疗中心的研究报告，乳腺癌相关淋巴水肿淋巴管静脉吻合术12个月之后的长期通畅性、生活质量、手臂周长（臂围）等临床结局的改善情况，并且探讨了吻合通畅与不通畅的影响因素及其与临床结局改善的相关性。 该单中心回顾研究对2016年1月～2018年5月荷兰马斯特里赫特大学医疗中心连续25例乳腺癌相关淋巴水肿淋巴管静脉吻合术患者术前和术后12个月吲哚菁绿淋巴造影、淋巴水肿国际功能分类问卷、臂围测量结果进行回顾分析。 结果，12个月后，76%的患者至少一条吻合通畅。根据淋巴水肿国际功能分类，生活质量显著提高（P<0.000）；不过，臂围未见明显减少。65%的患者不再穿弹力袖套。 吻合通畅组与吻合不通畅组相比，生活质量改善、臂围减少、停用弹力袖套较多，并且术前和术后的感染率较低、术前淋巴水肿持续时间较短、早期淋巴水肿率和吲哚菁绿显影率较高，不过均无统计学意义。 因此，该研究结果表明，淋巴管静脉吻合术12个月后通畅性可接受，吻合通畅性与临床结局改善存在正相关性，故有必要对更大样本人群开展进一步前瞻研究，以确定淋巴管静脉吻合术后的结局或患者特征是否与吻合通畅性显著相关。 Breast Cancer Res Treat. 2019 Sep 21. Correlation between patency and clinical improvement after lymphaticovenous anastomosis (LVA) in breast cancer-related lymphedema: 12-month follow-up. Joost A. G. N. Wolfs, Luuke G. E. H. de Joode, René R. W. J. van der Hulst, Shan S. Qiu. Maastricht University Medical Center, Maastricht, The Netherlands. PURPOSE: Breast cancer-related lymphedema (BCRL) is caused by an interruption of the lymphatic system after breast cancer treatment. Lymphaticovenous anastomosis (LVA), by which one or more patent lymphatic collecting vessels are connected to subcutaneous veins, shows promising results. Postoperatively, the patency of these anastomosis can be evaluated; however, little is known concerning the long-term patency after LVA in patients with BCRL. The aim of this study was to analyse the long-term patency, quality of life (QoL) and arm circumference after LVA, and to explore differences between patent and non-patent anastomosis and its correlation with clinical improvement. METHODS: Twenty-five patients underwent indocyanine green (ICG) lymphography, lymph ICF-questionnaire, and arm circumference measurement preoperatively and 12 months after the LVA procedure. RESULTS: Seventy-six percent of the patients showed at least one patent anastomosis after 12 months. Quality of life according to the Lymph-ICF increased significantly (p<0.000); however, arm circumference showed no significant decrease. Sixty-five percent discontinued wearing compression stockings. The patent anastomosis group, compared with the non-patent anastomosis group showed, without significance, more improvement in QoL, arm circumference, and discontinuation of compression stockings, as well as a lower rate of infections both pre- and postoperatively, a shorter duration of lymphedema preoperatively, and a higher rate of early lymphedema and ICG stage. CONCLUSIONS: LVA showed an acceptable patency and positive correlation between a patent anastomosis and clinical improvement after 12 months. Further research with a larger study population is required to determine whether outcomes or patient characteristics significantly correlate with a patent anastomosis after LVA operation. KEYWORDS: LVA Lymphaticovenous anastomosis Breast cancer-related lymphedema Patency Quality of life DOI: 10.1007/s10549-019-05450-2
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