切换至 "中华医学电子期刊资源库"

中华移植杂志(电子版) ›› 2024, Vol. 18 ›› Issue (02) : 123 -128. doi: 10.3877/cma.j.issn.1674-3903.2024.02.010

综述

自体淋巴结移植治疗淋巴水肿研究进展
陈朔1,()   
  1. 1. 310003 杭州,浙江大学医学院附属第一医院放射科
  • 收稿日期:2023-04-21 出版日期:2024-04-25
  • 通信作者: 陈朔

Advances in the autologous lymph node transplantation for the treatment of lymphedema

Shuo Chen1,()   

  1. 1. Department of Radiology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
  • Received:2023-04-21 Published:2024-04-25
  • Corresponding author: Shuo Chen
引用本文:

陈朔. 自体淋巴结移植治疗淋巴水肿研究进展[J]. 中华移植杂志(电子版), 2024, 18(02): 123-128.

Shuo Chen. Advances in the autologous lymph node transplantation for the treatment of lymphedema[J]. Chinese Journal of Transplantation(Electronic Edition), 2024, 18(02): 123-128.

淋巴水肿是一种慢性、进行性、需要终身治疗的致残性疾病,可发生在身体的任何部位,四肢最为常见,临床表现为患肢的慢性肿胀、局部疼痛、皮肤萎缩和易感染。非增强磁共振淋巴管造影作为一种客观、可重复的影像学检查方法,可用于淋巴水肿的诊断和鉴别诊断、指导治疗以及疗效评价。过去十年,自体淋巴结移植取得了显著进展,成为治疗淋巴水肿的可行选择。本文综述淋巴水肿和自体淋巴结移植领域的最新进展,包括淋巴水肿的诊断、自体淋巴结移植手术的发展历史、适应证、供区和受区的选择、手术注意事项和术后常见并发症等。

Lymphedema is a chronic, progressive, and disabling condition that requires lifelong treatment and can occur anywhere in the body, most commonly in the extremities, with clinical manifestations of chronic swelling, local pain, skin atrophy, and susceptibility to infection of the affected limb. As an objective and repeatable imaging examination method, unenhanced magnetic resonance lymphangiography can be used for the diagnosis and differential diagnosis of lymphedema, guiding treatment and efficacy evaluation. Great progress has been achieved in of lymph node transplantation over the past 10 years. Currently, lymph node transplantation is no longer considered an experimental procedure and has become a selective therapy in patients with lymphedema. This article summarizes recent advances in lymphedema and lymph node transplantation, including lymphedema, surgical indications, donor sites and recipient sites, surgical precautions and common postoperative complications.

1
Grada AA, Phillips TJ. Lymphedema: pathophysiology and clinical manifestations[J]. J Am Acad Dermatol, 201777(6):1009-1020.
2
Grada AA, Phillips TJ. Lymphedema: diagnostic workup and management[J]. J Am Acad Dermatol, 201777(6):995-1006.
3
Armer JM, Stewart BR. A comparison of four diagnostic criteria for lymphedema in a post-breast cancer population[J]. Lymphat Res Biol, 20053(4):208-217.
4
Fu MR, Cleland CM, Guth AA, et al. L-dex ratio in detecting breast cancer-related lymphedema: reliability, sensitivity, and specificity[J]. Lymphology, 201346(2):85-96.
5
McLaughlin SA, Bagaria S, Gibson T, et al. Trends in risk reduction practices for the prevention of lymphedema in the first 12 months after breast cancer surgery[J]. J Am Coll Surg, 2013216(3):380-389.
6
Fu MR, Ridner SH, Hu SH, et al. Psychosocial impact of lymphedema: a systematic review of literature from 2004 to 2011[J]. Psychooncology, 201322(7):1466-1484.
7
Greene AK, Goss JA. Diagnosis and staging of lymphedema[J]. Semin Plast Surg, 201832(1):12-16.
8
Narushima M, Yamamoto T, Ogata F, et al. Indocyanine green lymphography findings in limb lymphedema[J]. J Reconstr Microsurg, 201632(1):72-79.
9
O′Donnell TF Jr, Rasmussen JC, Sevick-Muraca EM. New diagnostic modalities in the evaluation of lymphedema[J]. J Vasc Surg Venous Lymphat Disord, 20175(2):261-273.
10
Lee YW, Lee SH, You HJ, et al. Lymphatic vessel mapping in the upper extremities of a healthy Korean population[J]. Arch Plast Surg, 201845(2):152-157.
11
Mazzei MA, Gentili F, Mazzei FG, et al. Highresolution MR lymphangiography for planning lymphaticovenous anastomosis treatment: a single-centre experience[J]. Radiol Med, 2017122(12):918-927.
12
Mazzei FG, Gentili F, Guerrini S, et al. MR lymphangiography: a practical guide to perform it and a brief review of the literature from a technical point of view[J]. BioMed Res Int, 2017:2598358.
13
Mitsumori LM, McDonald ES, Neligan PC, et al. Peripheral magnetic resonance lymphangiography: techniques and applications[J]. Tech Vasc Interv Radiol, 201619(4):262-272.
14
Dori Y. Novel lymphatic imaging techniques[J]. Tech Vasc Interv Radiol, 201619(4):255-261.
15
Bae JS, Yoo RE, Choi SH, et al. Evaluation of lymphedema in upper extremities by MR lymphangiography: comparison with lymphoscintigraphy[J]. Magn Reson Imaging, 201849:63-70.
16
Weiss M, Burgard C, Baumeister R, et al. Magnetic resonance imaging versus lymphoscintigraphy for the assessment of focal lymphatic transport disorders of the lower limb: first experiences[J]. Nuklearmedizin, 201453(5):190-196.
17
Olszewski WL, Liu NF. Magnetic resonance lymphography (MRL): point and counter-point[J]. Lymphology, 201346(4):202-207.
18
McDonald RJ, McDonald JS, Kallmes DF, et al. Intracranial gadolinium deposition after contrast-enhanced MR imaging[J]. Radiology, 2015275(3):772-782.
19
Stojanov D, Aracki-Trenkic A, Benedeto-Stojanov D. Gadolinium deposition within the dentate nucleus and globus pallidus after repeated administrations of gadolinium-based contrast agents-current status[J]. Neuroradiology, 201658(5):433-441.
20
Kanda T, Matsuda M, Oba H, et al. Gadolinium deposition after contrast-enhanced MR imaging[J]. Radiology, 2015277(3):924-925.
21
Arrivé L, Derhy S, Dahan B, et al. Primary lower limb lymphoedema: classification with non-contrast MR lymphography[J]. Eur Radiol, 201828(1):291-300.
22
Cellina M, Oliva G, Menozzi A, et al. Non-contrast magnetic resonance lymphangiography: an emerging technique for the study of lymphedema[J]. Clin Imaging, 201953:126-133.
23
Arrivé L, Derhy S, El Mouhadi S, et al. Noncontrast magnetic resonance lymphography[J]. J Reconstr Microsurg, 201632(1):80-86.
24
Kayıran O, De La Cruz C, Tane K, et al. Lymphedema: from diagnosis to treatment[J]. Turk J Surg, 201733(2):51-57.
25
Garza R 3rd, Skoracki R, Hock K, et al. A comprehensive overview on the surgical management of secondary lymphedema of the upper and lower extremities related to prior oncologic therapies[J]. BMC Cancer, 201717(1):468.
26
Arrivé L, Derhy S, Dlimi C, et al. Noncontrast magnetic resonance lymphography for evaluation of lymph node transfer for secondary upper limb lymphedema[J]. Plast Reconstr Surg, 2017140(6):806e-811e.
27
Petrek JA, Pressman PI, Smith RA. Lymphedema: current issues in research and management[J]. CA Cancer J Clin, 200050(5):292-307.
28
Case TC, Witte CL, Witte MH, et al. Magnetic resonance imaging in human lymphedema: comparison with lymphangioscintigraphy[J]. Magn Reson Imaging, 199210(4):549-558.
29
Donahue MJ, Donahue PC, Rane S, et al. Assessment of lymphatic impairment and interstitial protein accumulation in patients with breast cancer treatment-related lymphedema using CEST MRI[J]. Magn Reson Med, 2016, 75(1): 345-355.
30
Crescenzi R, Donahue PMC, Mahany H, et al. CEST MRI quantification procedures for breast cancer treatment-related lymphedema therapy evaluation[J]. Magn Reson Med, 2020, 83(5):1760-1773.
31
Douglass J, Graves P, Gordon S. Self-care for management of secondary lymphedema: a systematic review[J]. PLoS Negl Trop Dis, 201610(6):e0004740.
32
Becker C, Assouad J, Riquet M, et al. Postmastectomy lymphedema: long-term results following microsurgical lymph node transplantation[J]. Ann Surg, 2006243(3):313-315.
33
Brown S, Mehrara BJ, Coriddi M, et al. A prospective study on the safety and efficacy of vascularized lymph node transplant[J]. Ann Surg, 2022276(4):635-653.
34
Visconti G, Constantinescu T, Chen PY, et al. The venous lymph node flap: concepts, experimental evidence, and potential clinical implications[J]. J Reconstr Microsurg, 201632(8):625-631.
35
Visconti G, Constantinescu T, Araki J, et al. The venous lymph node flap for the treatment of peripheral lymphedema: preliminary evidence[J]. Microsurgery, 201737(1):86-87.
36
Ito R, Suami H. Overview of lymph node transfer for lymphedema treatment[J]. Plast Reconstr Surg, 2014134(3):548-556.
37
Ogunleye AA, Nguyen DH, Lee GK. Surgical treatment of lymphedema[J]. JAMA Surg, 2020155(6):522-523.
38
Ward J, King I, Monroy-Iglesias M, et al. A meta-analysis of the efficacy of vascularised lymph node transfer in reducing limb volume and cellulitis episodes in patients with cancer treatment-related lymphoedema[J]. Eur J Cancer, 2021151:233-244.
39
Winters H, Tielemans HJP, Paulus V, et al. A systematic review and meta-analysis of vascularized lymph node transfer for breast cancer-related lymphedema[J]. J Vasc Surg Venous Lymphat Disord, 202210(3):786-795.
40
简扬,邓呈亮,魏在荣. 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[J].中国修复重建外科杂志202337(2):240-246.
41
Chang DW. Combined approach to surgical treatment of lymphedema[J]. Lymphat Res Biol, 202119(1):23-24.
42
Tourani SS, Taylor GI, Ashton MW. Vascularized lymph node transfer: a review of the current evidence[J]. Plast Reconstr Surg, 2016137(3): 985-993.
43
Raju A, Chang DW. Vascularized lymph node transfer for treatment of lymphedema: a comprehensive literature review[J]. Ann Surg, 2015, 261(5):1013-1023.
44
Allen RJ Jr, Cheng MH. Lymphedema surgery: patient selection and an overview of surgical techniques[J]. J Surg Oncol, 2016113(8):923-931.
45
Granzow JW, Soderberg JM, Kaji AH, et al. Review of current surgical treatments for lymphedema[J]. Ann Surg Oncol, 201421(4):1195-1201.
46
Cheng MH, Chen SC, Henry SL, et al. Vascularized groin lymph node flap transfer for postmastectomy upper limb lymphedema: flap anatomy, recipient sites, and outcomes[J]. Plast Reconstr Surg, 2013131(6):1286-1298.
47
Maegawa J, Mikami T, Yamamoto Y, et al. Types of lymphoscintigraphy and indications for lymphaticovenous anastomosis[J]. Microsurgery, 201030(6):437-442.
48
Becker C, Vasile JV, Levine JL, et al. Microlymphatic surgery for the treatment of iatrogenic lymphedema[J]. Clin Plast Surg, 201239(4):385-398.
49
Becker C. Autologous lymph node transfers[J]. J Reconstr Microsurg, 201632(1):28-33.
50
Koshima I, Narushima M, Yamamoto Y, et al. Recent advancement on surgical treatments for lymphedema[J]. Ann Vasc Dis, 20125(4):409-415.
51
Suami H, Chang DW. Overview of surgical treatments for breast cancer-related lymphedema[J]. Plast Reconstr Surg, 2010126(6):1853-1863.
52
Chang DW, Suami H, Skoracki R. A prospective analysis of 100 consecutive lymphovenous bypass cases for treatment of extremity lymphedema[J]. Plast Reconstr Surg, 2013132(5):1305-1314.
53
Akita S, Mitsukawa N, Rikihisa N, et al. Early diagnosis and risk factors for lymphedema following lymph node dissection for gynecologic cancer[J]. Plast Reconstr Surg, 2013131(2):283-290.
54
Patel KM, Lin CY, Cheng MH. Effectiveness of lymphatic microsurgical procedures in the treatment of primary lymphedema[J]. Plast Reconstr Surg, 2015136(4S):135-136.
55
Yamamoto T, Matsuda N, Doi K, et al. The earliest finding of indocyanine green lymphography in asymptomatic limbs of lower extremity lymphedema patients secondary to cancer treatment: the modified dermal backflow stage and concept of subclinical lymphedema[J]. Plast Reconstr Surg, 2011128(4):314e-321e.
56
Lee BB. Contemporary issues in management of chronic lymphedema: personal reflection on an experience with 1065 patients[J]. Lymphology, 200538(1):28-31.
57
Nicoli F, Orfaniotis G, Lazzeri D, et al. The latissimus dorsi-groin-lymph node compound flap: a comprehensive technique with three features including skin coverage, restoration of motor function, and prevention of upper limb lymphedema[J]. Microsurgery, 201636(8):689-694.
58
Scaglioni MF, Meroni M, Fritsche E, et al. Combined pedicled superficial circumflex iliac artery perforator (SCIP) flap with lymphatic tissue preservation and lymphovenous anastomosis (LVA) for defect reconstruction and lymphedema-lymphocele prevention in thigh sarcoma surgery: preliminary results[J]. J Surg Oncol, 2021123(1),:96-103.
59
Ciudad P, Escandón JM, Manrique OJ, et al. Lymphedema prevention and immediate breast reconstruction with simultaneous gastroepiploic vascularized lymph node transfer and deep inferior epigastric perforator flap: a case report[J]. Microsurgery, 202242(6):617-621.
60
Liu HL, Chung JC. The lymph node content of supraclavicular lymph node flap: a histological study on fresh human specimens[J]. Lymphat Res Biol, 201917(5):537-542.
61
Chilgar RM, Khade S, Chen HC, et al. Surgical treatment of advanced lymphatic filariasis of lower extremity combining vascularized lymph node transfer and excisional procedures[J]. Lymphat Res Biol, 201917(6):637-646.
62
Chung JH, Hwang YJ, Park SH, et al. Preliminary outcomes of combined surgical approach for lower extremity lymphedema: Supraclavicular lymph node transfer and lymphaticovenular anastomosis[J]. J Plast Surg Hand Surg, 2022, 56(5):261-269.
63
李平,何波,杨羿,等. 血管化锁骨上窝淋巴结皮瓣移植治疗肢体淋巴水肿近期疗效[J].中华显微外科杂志201740(3):218-221.
64
Howell AC, Gould DJ, MayfieldC, et al. Anatomic basis of the gastroepiploic vascularized lymph node transfer: a radiographic evaluation using computed tomography angiography[J]. Plast Reconstr Surg, 2018142(4):1046-1052.
65
Scaglioni MF, Arvanitakis M, Chen YC, et al. Comprehensive review of vascularized lymph node transfers for lymphedema: outcomes and complications[J]. Microsurgery, 201838(2): 222-229.
66
Asuncion MO, Chu SY, Huang YL, et al. Accurate prediction of submental lymph nodes using magnetic resonance imaging for lymphedema surgery[J]. Plast Reconstr Surg Glob Open, 20186(3):e1691.
67
Paulus VAA, Winters H, Hummelink S, et al. Submental flap for vascularized lymph node transfer; a CTA-based study on lymph node distributio [J]. J Surg Oncol, 2020122(6):1226-1231.
68
Tinhofer IE, Meng S, Steinbacher J, et al. The surgical anatomy of the vascularized lateral thoracic artery lymph node flap-A cadaver study[J]. J Surg Oncol, 2017116(8):1062-1068.
69
Gazyakan E, Bigdeli AK, Kneser U, et al. Chimeric thoracodorsal lymph node flap with a perforator -based fasciocutaneous skin island for treatment of lower extremity lymphedema: a case report[J]. Microsurgery, 202040 (7):792-796.
70
Barreiro GC, Baptista RR, Kasai KE, et al. Lymph fasciocutaneous lateral thoracic artery flap: anatomical study and clinical use[J]. J Reconstr Microsurg, 201430(6):389-396.
71
Koshima I, Narushima M, Mihara M, et al. Lymphadiposal flaps and lymphaticovenular anastomoses for severe leg edema: Functional reconstruction for lymph drainage system[J]. J Reconstr Microsurg, 201632(1):50-55.
72
Kwak MD, Machens HG. The lateral intercostal artery perforator as an alternative donor vessel for free vascularized lymph node transplantation[J]. Arch Plast Surg, 201845(3):275-279.
[1] 周容, 张亚萍, 廖宇, 程晓萍, 管玉龙, 潘广玉, 闫杰, 王贤芝, 苟中山, 潘登科, 李巅远. 超声在基因编辑猪-猴异种并联式心脏移植术中的应用价值[J]. 中华医学超声杂志(电子版), 2024, 21(06): 617-623.
[2] 项文静, 徐燕, 茹彤, 郑明明, 顾燕, 戴晨燕, 朱湘玉, 严陈晨. 神经学超声检查在产前诊断胼胝体异常中的应用价值[J]. 中华医学超声杂志(电子版), 2024, 21(05): 470-476.
[3] 中华医学会器官移植学分会, 中国医师协会器官移植医师分会. 中国活体肝移植供者微创手术技术指南(2024版)[J]. 中华普通外科学文献(电子版), 2024, 18(04): 241-252.
[4] 田文. 甲状腺癌功能性根治颈淋巴结清扫术[J]. 中华普外科手术学杂志(电子版), 2024, 18(05): 482-482.
[5] 高一飞, 刘根祥, 孙长华, 周广军. 喉返神经监测在无充气腋窝入路腔镜单侧甲状腺切除+中央区淋巴结清扫术中的应用效果[J]. 中华普外科手术学杂志(电子版), 2024, 18(05): 483-486.
[6] 韩婧, 郝少龙, 康骅. 北京市单中心甲状腺癌患者临床特征的回顾分析[J]. 中华普外科手术学杂志(电子版), 2024, 18(05): 490-493.
[7] 宋佳, 汪波, 孙凯律, 商江峰, 吴旦平, 肇毅. 吲哚菁绿荧光显影联合亚甲蓝染色在乳腺癌前哨淋巴结活检中的应用[J]. 中华普外科手术学杂志(电子版), 2024, 18(05): 498-501.
[8] 蔡永芹, 王君菊, 张敬敬. 不同下纵隔淋巴结清扫顺序在Siewert Ⅱ型食管胃结合部腺癌中应用效果研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(05): 562-565.
[9] 崔宏帅, 冯丽明, 东维玲, 韩博. 腹腔镜右半结肠癌D3根治术+IGLN清扫术治疗局部进展期结肠肝曲癌的临床效果研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(05): 566-569.
[10] 丁志翔, 于鹏, 段绍斌. 血浆BRAF基因检测对腹腔镜右半结肠癌D3根治术中行幽门淋巴结清扫的指导价值[J]. 中华普外科手术学杂志(电子版), 2024, 18(05): 570-573.
[11] 张金华, 赵锁. 早期ICC腹腔镜肝切除术不同淋巴结清扫范围的近远期效果对比研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(05): 578-581.
[12] 唐丹萍, 王萍, 江孟蝶, 杨晓蓉. 自体脂肪移植在乳腺癌术后乳房重建的研究进展[J]. 中华普外科手术学杂志(电子版), 2024, 18(05): 582-585.
[13] 黄一博, 李至彦, 林晨, 陶亮, 王萌, 管文贤. 胃癌根治术中淋巴结示踪剂的研究进展[J]. 中华普外科手术学杂志(电子版), 2024, 18(05): 586-588.
[14] 史成宇, 季晓琳, 田莉莹, 张来香. 腹腔镜胰十二指肠切除术中第14c/d组淋巴结清扫在胰头癌中的临床效果研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(04): 430-433.
[15] 黄宏山, 陈成彩. 经淋巴管超声造影在乳腺癌前哨淋巴结诊断中的研究进展[J]. 中华临床医师杂志(电子版), 2024, 18(04): 411-414.
阅读次数
全文


摘要