摘要目的 探讨淋巴脂肪抽吸减容术治疗下肢原发性淋巴水肿的疗效并进行相关分析.方法 2016年7月至2017年8月北京世纪坛医院收治的下肢原发性淋巴水肿患者30例,其中男性13例,女性17例,年龄(36.0± 16.3)岁.应用淋巴脂肪抽吸减容术对患肢进行治疗,记录手术出血量、脂肪量、手术时间、手术前后患肢体积变化以及患者主观评价.将所得数据分别以患者性别、是否存在丹毒史及不同病变分期进行分组比较.结果 在淋巴脂肪抽吸减容术中,脂肪吸出量900～3 900 ml,出血量160～1 100 ml.(1)患肢术前、术毕及术后3个月的体积差百分比分别为(31.4±16.4)％、(6.6±10.0)％、(12.2±10.7)％,术毕、术后3个月均比术前明显降低,差异均有统计学意义(t=7.050、P=0.000,t=5.365、P=0.000),术后3个月比术毕升高,差异有统计学意义(t=-2.088,P=0.041).(2)不同性别间比较,术中抽出脂肪量及抽脂速度女性高于男性,术中出血量、术前体积差百分比、术毕体积差百分比、术后3个月体积差百分比男性均高于女性,差异均有统计学意义(P＜0.05).(3)丹毒组与非丹毒组间比较,术中出血量丹毒组高于非丹毒组,术中抽出脂肪量及抽脂速度丹毒组均低于非丹毒组,差异均有统计学意义(P＜0.05).(4)Ⅱ期组与Ⅲ期组比较,术中抽出脂肪量及抽脂速度Ⅱ期组高于Ⅲ期组,而术中出血量、术前体积差百分比、术毕体积差百分比、术后3个月体积差百分比Ⅱ期组均低于Ⅲ期组,差异均有统计学意义(P＜0.05).(5)术后3个月患者主观感觉患肢沉重、疲乏感较术前减轻,触痛及紧绷感觉较术前加重,差异有统计学意义(P＜0.05).结论 淋巴脂肪抽吸减容术对下肢原发性淋巴水肿的肢体减容治疗具有一定效果,但需早期结合其他改善淋巴回流的治疗方法.患者的性别、疾病分期及是否反复丹毒病史是手术操作难度和预后的影响因素.

abstractsObjective To investigate outcome and clinical value of liposuction in primary lymphedema of lower extremities.Methods Thirty patients with primary lymphedema in unilateral lower extremity were recruited in this study from July 2016 to August 2017 in Beijing Shijitan Hospital.There were 13 male and 17 female patients,with the average age of (36± 16.3) years.All the patients were underwent liposuction.The volume of hemorrhage and lipid,operation time and the volume changes of affected extremity were recorded.The subjective evaluation of the patients were also proceed.The patients were divided into different groups according to gender,stage and erysipelas history.Results Total lipid volume is 900-3 900 ml.The hemorrhage volume is 160-1 100 ml during liposuction.The ipsilateral-contralateral percent volume of lower extremity was decreased immediately after surgery (6.6％ ± 10.0％,t =7.050,P=0.000),and 3 months postoperatively (12.2％ ± 10.7％,t =5.365,P =0.000),whencompared with preoperative (31.4％±16.4％).However,the percent volume was increased 3 months after surgery,compared to immediately postoperative measurements (t =-2.088,P =0.041).Female patients had more lipid volume and higher liposuction rate than males,whereas male patients show more affected extremities volume before,after and in 3-month follow-up.The hemorrhage volume was also higher in male than female patients.Patients with erysipelas had higher volume of hemorrhage,with lower lipid volume and liposuction rate.Stage Ⅱ patients show higher lipid volume and liposuction rate than stage Ⅲ patients in operation,with lower hemorrhage and affected extremity volume changes in before,after and 3-month follow-up.In subjective assessment,the experienced heaviness and fatigue was alleviated in all patients,while the pain and tightness was increased.Conclusions Liposuction is an effective therapy for primary lymphedema in lower extremity.It is necessary to combine with other therapies to improve lymph circulation.Patients' gender,stage and the history of erysipelas are the main influencing factors of operation difficulty and prognosis.