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Objective:To investigate the diagnosis of malignancy with upper limb lymphedema as the initial sign and symptoms.Methods:Clinical data of 6 patients with malignant lymphedema admitted at the Department of Lymphatic Surgery, Beijing Shijitan Hospital, Capital Medical University, from May 2007, to Dec 2018 were retrospectively analyzed.Results:The age of these 6 patients ranged from 50 to 78 years. The time from the occurrence of lymphedema to the diagnosis of malignant tumors ranged from 1 month to 15 years. Limb swelling occurred in all 6 cases. Local lymphadenopathy occurred in 4 cases and limb paresthesia occurred in 2 cases. Pathological diagnosis showed that the tumor originated from epithelial tissue in 3 cases, mesenchymal tissue in 2 cases and lymphatic system in 1 case. Pathological diagnosis showed that the tumor originated from epithelial tissue in 3 cases, mesenchymal tissue in 2 cases and lymphatic system in 1 case.Conclusions:To avoid delays in the diagnosis and therapy of malignant lymphedema, physicians should actively look for signs or symptoms of lymphedema during the follow-up period and promptly manage patients developing problems.
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Objective:To evaluate peritoneovenous shunt for treatment of refractory chylous ascites.Methods:The clinical data of 40 patients with refractory chylous ascites treated by peritoneovenous shunt procedure at Department of Lymphatic Surgery, Beijing Shijitan Hospital, Capital Medical University from May 2008 to Aug 2020 were retrospectively analyzed.Results:Patients'postoperative weight [(57.8±13.2) kg] was significantly lower than that of preoperative weight [(65.9±13.1) kg]. Postoperative abdominal circumference significantly reduced [(82.0±9.8) cm vs. (94.3±10.8) cm]. Average postoperative 24-hour urine output was significantly higher than that before operation [2 250 (1 650, 3 300) ml vs. 750 (500, 1 000) ml]. Platelet count and fibrinogen decreased after operation; prothrombin time (PT) prolonged; the change of time of activated partial thromboplastin (APTT) was not statistically significant ( P=0.506). Postoperative aspartate aminotransferase (AST), urea, and creatinine decreased; whereas alanine aminotransferase (ALT) ( P=0.154), total protein ( P=0.350), and albumin ( P=0.113) remained unchanged. 35 patients got follow-up, 29 deceased. The survival time with tube was 16 (7,37) months; 6 cases survived, the survival time with tube was 28 (6,124) months. Conclusions:Peritoneovenous shunt is a palliative surgery improving the quality of life of patients with refractory chylous ascites.
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Objective:To explore the clinical features of Stewart-Treves syndrome in postoperative patients of breast cancer.Methods:The clinical data of 11 patients with Stewart-Treves syndrome after breast cancer surgery in Beijing Shijitan Hospital from Aug 2008 to Sep 2016 were retrospectively analyzed.Results:All the 11 patients were female , age ranging from 44 to 78 years.The main clinical manifestations included multiple skin and subcutaneous nodules , scattered red or purplish red rashes in the lymphedematous upper limbs, and sometimes in the chest wall. MRI showed multiple short T2 signal soft tissue nodules in skin and subcutaneous soft tissue. Histopathology showed heterogeneous endothelial cell-derived malignant tumor. Immunohistochemical staining showed positive CD31, CD34 and D2-40. These 11 patients had skin and subcutaneous tumor excision and biopsy, 4 had shoulder amputation, 4 received postoperative adjuvant chemo plus or radiotherapy. As of Feb 2020, 1 patient was alive, 9 died and 1 lost follow-up.Conclusions:Stewart-Treves syndrome is a rare complication of breast cancer, with poor prognosis and high mortality.
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Objective:To study the clinical effect of liposuction combined with lymphatico-venous anastomosis for treatment of breast cancer-related lymphedema(BCRL).Methods:From Nov 2015 to Nov 2017, 111 patients with BCRL admitted to the Department of Lymphatic Surgery at Beijing Shijitan Hospital were enrolled. The rank-sum test was used for statistical analysis. The frequencies of erysipelas episodes before and after combined surgeries were compared.Results:The mean upper limb circumference significantly decreased at 7 days[0.2 cm (-0.8, 1.1)], at follow-up[0.2 cm(-0.4, 1.0)]compared with that of preoperation[5.0 cm(4.1, 6.9)]( P<0.05). The mean upper limb volume significantly decreased at day 7[26 ml(-120, 155)], at follow-up[37 ml(-66, 165)]compared with preoperation[786 ml(632, 1 200)]( P<0.05). The incidence of erysipelas of the affected limbs significantly decreased after treatment. Furthermore, the softness and the feeling of heaviness of the affected limbs significantly improved after the combined procedures(all P<0.05). Conclusion:Liposuction combined with lymphatico-venous anastomosis is an effective method for the treatment of breast cancer-related lymphedema.
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Objective@#To investigate the imaging features and etiology of lymphatic trunk in primary facial lymphedema.@*Methods@#26 patients with primary facial lymphedema patients (F/M, 13/13, ages 21.8 ± 13.9 years old) were recruited from January 2015 to October 2017 in this study, with 32 sides facial lymphedema reported, including 6 right facial lymphedema, 14 left facial lymphedema, and 6 bilateral facial lymphedema. And all the patient data and imaging were retrospective analysis to summarize the MR imaging features of thoracic duct and right lymphatic duct, meanwhile compared with surgical results.@*Results@#For all 26 patients, MR imaging result in thoracic duct manifests 32 lymphatic duct, including 20 thoracic duct and 12 right lymphatic duct. The imaging features demonstrate two typical findings: dilated(13 cases) and slim(7 cases) demonstrations. While for right lymphatic duct, the MR result included three types: dilated(6 cases), slim(4 cases) and no sign of manifestations(2 cases). In surgery, the thoracic duct in cervical segment demonstrated abnormal structures, including capsulated by fibrous tissues in peripheral area(30 sides), surrounded by internal jugular vein sheath(11 sides), external pressed by venae cervicalis transversa(5 sides) and lymphatic trunk dysplasia(2 sides).@*Conclusions@#MR thoracic duct and right lymphatic duct imaging can be used as an effective diagnostic imaging method for primary facial lymphedema, and the structural anomaly of the upper cervical catheter and the right lymphatic catheter may be one of the pathogenic factors of primary facial lymphedema.
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Objective@#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), when compared 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 Ⅱpatients 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.
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Objective@#To study the clinical effects of liposuction combined with lymphatico-venous anastomosis for treatment of secondary lymphedema of the lower limbs.@*Methods@#A retrospective analysis was performed for 49 patients who had undergone liposuction combined with lymphatico-venous anastomosis to treat secondary lymphedema of the lower limbs at Department of Lymph Surgery, Beijing Shijitan Hospital from November 2013 to February 2015.All patients were female aging from 31 to 70 years with median age of (52±10)years.All patients had history of pelvic surgery.There were 32 cases with cervical carcinoma, 11 cases with endometrial cancer, 1 case with ovarian cancer who accepted radical hysterectomy, 2 cases with benign tumor who accepted resection, 2 cases accepted inguinal lymph node dissection, 1 case with rectal cancer accepted radical resection.There were 30 cases with history of radiation therapy and 23 cases with history of erysipelas recurrent((2.1±3.9)/year). The limb swelling degree in preoperative and postoperative patients was explored using one-way analysis of variance with replicate measures and paired sample t-test. Meanwhile the incidence of lymphogenous infection was used as an evaluation of operation efficacy.@*Results@#The mean lower limb circumference difference at 7 days, 6 months and 12 months was (0.17±1.36)cm, (1.25±1.62)cm and(1.58±1.56)cm, respectively, which was significantly decreased compared with preoperative((4.92±2.16)cm) (t=-5.712, -5.777, -5.765; all P<0.01). The mean lower limb volume difference at 7 days, 6 months and 12 months was (522±799)ml, (726±973)ml and (889±895)ml, respectively, which was significantly decreased compared with preoperative((2 729±1 335) ml)(t=-5.905, -6.093, -5.777; all P<0.01). The incidence of erysipelas was 0.0(0.0, 0.0)/6 months within 6 months after operation and 0.0(0.0, 0.0)/6 months within 6-12 months after operation, which was significantly lower than that before operation(0.0(0.0, 2.0)/year). The feeling of tightness and heaviness of the limb was significantly improved compared with preoperative.@*Conclusion@#Liposuction combined with lymphatico-venous anastomosis is an effective method for the treatment of secondary lymphedema of the lower limbs.
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Objective To analyze the curative effect of oxaliplatin combined with S-1 in the treatment of advanced colorectal cancer.Methods Totally 90 cases of patients with advanced colorectal cancer in Shangluo No.2 Provincial People's Hospital from January 2013 to August 2015 were divided into observation group and control group,45 cases in each group.Patients in control group were treated with oxaliplatin combined with fluorouracil,4 weeks for one cycle of treatment,and patients in observation group were treated with oxaliplatin combined with S-l,21 d for one cycle.The curative effects,adverse reactions,life quality,and one year survival rate were compared between two groups.Results After treatment,the total remission rate of observation group was higher than that of control group,and the disease control rate was lower than that of the control group,but there was no significant difference between the two groups.During the treatment,there were no significant differences in Ⅰ degree and Ⅱ degree adverse reactions between two groups;But the adverse reactions of level Ⅲ and level Ⅳ of gastrointestinal reaction,liver function damage,reduce the incidence of white blood cells in observation group were significantly lower than that of control group (P ＜ 0.05).There was no significant difference between the two groups in the SF-36 scale scores.The one year survival rate of observation group was (21/45),and the survival rate of the control group after treatment was 42.22％ (19/45) in the control group,and there was no significant difference between the two groups in the one year survival rate.Conclusion Compared with oxaliplatin combined with fluorouracil,oxaliplatin combined with S-1 has equivalent efficacy and life quality,but the adverse reactions in gastrointestinal tract,liver,and marrow were better.
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Objective To investigate the clinical value of CT lymphangiography (CTL) combined with direct lymphangiography (DLG) in primary intestinal lymphangiectasia (PIL). Methods Sixteen patients diagnosed as PIL with intestinal enteroscopy were recruited in this retrospective study. All the patients were performed DLG and CTL one week before exploratory laparotomy. Subjective assessment in DLG included weak lymphatic fluid drainage, lymphangiectasia, lymphatic reflux, fistula and thoracic outlet reflux or obstruction. While for CTL combined with DLG, the intestinal and extra-intestinal lesions were evaluated, including lymph node, edema, lymphangiectasia and abnormal distribution, fistula, and lymphangiomatosis. All the diagnosis was compared with intestinal endoscopy results. Results For DLG, 16 weak lymphatic fluid drainages, 9 lymphangiectasia, 1 fistula with abdomen and 14 thoracic outlets weak lymphatic fluid drainage or obstruction were found. For DLG combined with CTL, 16 intestinal lumens dilatation and 14 circumferential intestinal thickening were found in intestinal lesions. While for extra-intestinal lesions, the imaging features included edematous findings (12 in mesentery, 7 ascites only, 2 hydrothorax and ascites, and 3 pericardial, thoracic and abdominal effusions), abdominal lymph nodes (6 cases), lymphangiectasia and abnormal distributions (14 cases), fistulas (lymph-intestinal luminal fistula in 4 cases, and lymph-abdominal fistula in 3 cases), lymphangiomatosis (3 cases), and thoracic duct outlet dysfunction and reflux (14 cases).The number of cases diagnosed as intestinal lymphangiectasia, intestinal luminal lymph exudation and lymph fistula were 16, 10 and 6 with intestinal endoscopy, while the number were 11, 0, and 4 with CTL combination with DLG. Conclusion Combination of CTL with DLG is valuable in the diagnosis of PIL.