Objective To introduce the Xie's 1+X surgical approach, a lymphatic microsurgical technique that combines multiple local lymphaticovenous anastomosis (LVA) at key points for the treatment of secondary lymphedema. Methods From January 2023 to June 2024, a total of 11 patients who developed secondary lymphedema after tumor resection combined with lymphadenectomy were treated using the Xie's 1+X surgical approach. The onset of lymphedema after tumor surgery ranged from 7 to 190 months, with an average of 24.5 months. The duration of lymphedema before surgical intervention ranged from 10 to 185 months, with an average of 42.6 months. All patients underwent treatment using the Xie's 1+X surgical technique. The postoperative follow-up period ranged from 2 to 12 months, with an average of 6.5 months. Results The severity of limb lymphedema, the stage of the affected limb, and the presence and timing of secondary cellulitis were recorded before and after surgery. Follow-up evaluations were conducted at preoperative baseline and at 1, 3, 6, and 12 months postoperatively. There were significant differences in comparative analysis of preoperative and postoperative indicators (P<0.05). Conclusions The Xie's 1+X microsurgical technique is an effective approach for addressing both the underlying causes and manifestations of secondary lymphedema. It offers significant advantages, including high treatment efficacy, minimal surgical incisions, and shorter operative time, making it a promising surgical option for secondary lymphedema management.
Key words
Secondary lymphedema /
/
/
LVA /
/
/
1+X surgical approach
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
[1] 尚翠侠，刘哲，沈剑南，等.乳腺癌术后淋巴水肿患者康复干预中的伦理问题及对此[J]. 中国医学理论理学,2022,35(1):62-65.DOI:10.12026/j.issn.1001-8565.2022.01.11.
[2] Badash I, Gould DJ, Patel KM. Supermicrosurgery: History, applications, training and the future[J]. Front Surg,2018,5:23. DOI: 10.3389/fsurg.2018.00023
[3] 刘长瑞,朱见,郑振华,等.显微外科技术在乳腺癌相关上肢淋巴水肿中的应用[J].中华乳腺病杂志(电子版),2020,14(2):109-111. DOI: 10.3877/cma.j.issn.1674-0807.2020.02.009.
[4] Paskett ED, Dean JA, Oliver JM, et al．Cancer-related lymphedema risk factors, diagnosis, treatment, and impact: a review[J].J Clin Oncol, 2012, 30（30）：3726-3733. DOI: 10.1200/JCO.2012.41.8574.
[5] Qin ES, Bowen MJ, Chen WF. Diagnostic accuracy of bioimpedance spectroscopy in patients with lymphedema: a retrospective cohort analysis[J]. J Plast Reconstr Aesthet Surg, 2018,71(7):1041-1050. DOI: 10.1016/j.bjps.2018.02.012.
[6] Zhang XC, Oliveri JM, Paskett ED. Features, predictors and treatment of breast cancer-related lymphedema[J]. Curr Breast Cancer Rep,2020,12(4):244-254. DOI: 10.1007/s12609-020-00381-0.
[7] Campisi C, Bellini C, Campisi C, et al. Microsurgery for lymphedema: clinical research and long-term results[J]. Microsurgery, 2010, 30(4): 256-260. DOI: 10.1002/micr.20737.
[8] Pusic AL, Cemal Y, Albomoz C, et al. Quality of life among breast cancer patients with lymphedema: a systematic review of patientreported outcome instruments and outcomes[J]. J Cancer Surviv, 2013, 7(1): 83-92. DOI: 10.1007/s11764-012-0247-5.
[9] Granzow, JW, JM Soderberg, AH Kaji, et al. Review of current surgical treatments for lymphedema[J]. Ann Surg Oncol, 2014,21(4):1195-1201. DOI: 10.1245/s10434-014-3518-8.
[10] Maruccia, M, A Pezzolla, E Nacchiero, et al. Efficacy and early results after combining laparoscopic harvest of double gastroepiploic lymph node flap and active physiotherapy for lower extremity lymphedema[J]. Microsurgery, 2019,39(8):679-687. DOI:10.1002/micr.30511.
[11] Maruccia, M, R Elia, P Ciudad, et al. Postmastectomy upper limb lymphedema: Combined vascularized lymph node transfer and scar release with fat graft expedites surgical and patients' related outcomes. A retrospective comparative study[J]. J Plast Reconstr Aesthetic Surg, 2019,72(6):892-901. DOI: 10.1016/j.bjps.2019.01.029.
[12] Mihara, M, H Hara, S Tange, et al. Multisite lymphaticovenular bypass using supermicrosurgery technique for lymphedema management in lower lymphedema cases[J]. Plast Reconstr Surg, 2016,138(1):262-272. DOI: 10.1097/PRS.0000000000002254.
[13] Koshima I, Y Nanba, T Tsutsui, et al. Long-term follow-up after lymphaticovenular anastomosis for lymphedema in the leg[J]. J Reconstr Microsurg, 19 (2003), 209-215. DOI:10.1055/s-2003-40575.
[14] Di Taranto, G, R Elia, V Amorosi, et al. The difference in the caliber of efferent lymphatic vessels among various lymph node flaps[J]. J Surg Oncol, 2018,118(7):1212-1213. DOI:10.1002/jso.25257.
[15] Campisi C. Lymphatic microsurgery: a potent weapon in the war on lymphedema[J]. Lymphology, 1995, 28(3): 110-112.
PDF(2991 KB)
