【周三·疼痛专题】腰椎交感神经阻滞治疗癌症相关继发性下肢淋巴水肿:一项回顾性研究

Lumbar Sympathetic Ganglion Block for CancerAssociated Secondary Lower Limb Lymphedema: A Retrospective Study 腰椎交感神经阻滞治疗癌症相关继发性下肢淋巴水肿:一项回顾性研究        

Background: Although lower limb lymphedema (LLL) is more or equally as frequent and harmful as upper limb lymphedema after cancer treatment, there are only a few studies on this topic. Cancer-related secondary LLL not only has physical implications, but also affects quality of life among patients who underwent gynecological cancer treatment. Despite numerous studies of various therapies, the optimal treatment for cancer-related LLL is still unknown.

背景:尽管在癌症治疗后，下肢淋巴水肿(LLL)的发生频率和危害与上肢淋巴水肿相当，但有关该课题的研究很少。癌症相关的继发性LLL不仅对身体有影响，还会影响接受妇科癌症治疗的患者的生活质量。尽管对各种治疗方法进行了大量的研究，但癌症相关的LLL的最佳治疗方法仍然未知。   

Objectives: We aimed to investigate the efficacy of lumbar sympathetic ganglion block (LSGB) in patients with secondary LLL in the present study.

目的:本研究旨在探讨腰交感神经节阻滞(lgb)治疗继发性LLL的疗效。   

Study Design: This study is a retrospective study.

研究设计:本研究为回顾性研究。

Setting: A single academic hospital, outpatient setting.

设置:一个单一的学术医院，门诊部。   

Methods: A total of 30 patients with secondary unilateral LLL and failed complex decongestive treatment, from January 2017 through May 2021, were reviewed for inclusion in this study. The patients underwent fluoroscopy-guided LSGB 2 times with the help of digital subtraction angiography at 3-day intervals. Leg circumference was measured, and the volume of the leg was calculated before surgery, on the first day after the first surgery, on the first day after the second surgery, and on the seventh day after the second surgery. The World Health Organization Quality of Life Instrument Questionnaire scores were monitored before and after LSGB.

方法:从2017年1月到2021年5月，共有30例继发性单侧LLL患者和复杂去充血治疗失败的患者被纳入本研究。在数字减影血管造影的帮助下，患者每隔3天进行2次透视引导下的LSGB检查。术前、第一次手术后第一天、第二次手术后第一天、第二次手术后第7天分别测量腿围，计算腿部容积。在LSGB治疗前后监测世界卫生组织生活质量工具问卷评分。   

Results: The leg circumference and volume decreased significantly from baseline after the treatment (P < 0.001). One week after 2 rounds of LSGB, the physical health score, psychological score, and social relationships score were higher than those before treatment (all P < 0.05). There was no difference in the environmental health score (P = 0.2731).

结果:治疗后患者腿围、腿体积较基线明显减小(P < 0.001)。2轮治疗后1周，患者身体健康评分、心理评分、社会关系评分均高于治疗前(均P < 0.05)。环境健康评分差异无统计学意义(P = 0.2731)。   

Limitations: This study was limited by its sample size and retrospective observational design.

局限性:本研究受样本量和回顾性观察设计的限制。   

Conclusions: LSGB can be a safe and effective treatment option for patients with secondary LLL after gynecological cancer treatment.

结论:对于妇科肿瘤治疗后继发LLL患者，LSGB是一种安全有效的治疗选择。

主要结果：      

1. The lower limb circumferences were dramatically reduced.After the first and the second LSGB, the leg circumference of the detected site was reduced, and the degree of reduction was obvious between the 2 times (P < 0.05), except for the foot. However, the degree of leg circumference reduction one week after the second LSGB showed no difference compared with one day after the second LSGB (P > 0.05). 下肢周长明显减小。第一次和第二次LSGB后，检测部位腿部周长减小，2次之间减小程度明显(P < 0.05)，除足外。然而，第二次LSGB后一周的腿围缩小程度与第二次LSGB后一天无差异(P > 0.05).

2. The patient’s leg volume decreased as the number of treatment increased, with the smallest leg volume at one week after the LSGB treatment (Fig. 5). Compared with baseline, there was a vast difference between pre and post7 (P < 0.05), and between post1 and post7 (P < 0.05).

患者的腿体积随着治疗次数的增加而减少，在LSGB治疗一周后腿体积最小。与基线相比，pre和post7之间有显著差异(P < 0.05)， post1和post7之间有显著差异(P < 0.05)。

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