Effectiveness of lymphaticovenular anastomosis combined with perioperative targeted drainage in treatment of secondary lower limb lymphedema: a prospective randomized trial_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Xiaoyan ¹ , DU Jing ² , ZHANG Xiaomao ¹ , LU Shaoying ¹ , ZHAO Liang ¹ ,  CAI Hui ¹

1. Department of Vascular Surgery, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an Shaanxi, 710089, P. R. China;
2. Department of Traditional Chinese Medicine Rehabilitation, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an Shaanxi, 710089, P. R. China;

Corresponding?author：

CAI Hui, Email: 422961391@qq.com

Keywords：

Secondary lymphedema; lymphaticovenular anastomosis; targeted drainage; randomized controlled trial; effectiveness analysis

DOI：

10.7507/1002-1892.202511050

Video：

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Objective To evaluate the effectiveness of lymphaticovenular anastomosis (LVA) combined with perioperative targeted multi-layer circular lymphatic drainage in the treatment of secondary lower limb lymphedema using a prospective randomized controlled trial. Methods In a prospective randomized controlled trial, 80 patients with secondary lower limb lymphedema admitted between January 2023 and September 2025 were initially enrolled and allocated to either the trial group (LVA+targeted lymphatic drainage) or the control group (LVA+conventional lymphatic drainage), 40 in each group. After 2 dropouts in the control group, 78 patients (40 in the trial group, 38 in the control group) were included for analysis. There was no significant difference in the baseline data (P>0.05), such as age, gender, disease duration, and preoperative lower limb circumference difference, functional scores, and levels of vascular endothelial growth factor C (VEGF-C), transforming growth factor β₁ (TGF-β₁), and interleukin 6 (IL-6). Both groups underwent LVA. The trial group received perioperative targeted multi-layer circular lymphatic drainage, while the control group received conventional manual lymphatic drainage. Changes in lower limb circumference difference, functional scores, and levels of VEGF-C, TGF-β₁, and IL-6 were compared between the two groups at various time points before and after operation. Overall effectiveness and safety were also assessed. Results All patients were followed up 3-12 months (mean, 6.5 months). Postoperatively, the trial group demonstrated significantly better functional recovery and a superior trend in lower limb circumference reduction at all time points compared to the control group (P<0.05). Serological analysis indicated a more pronounced increase in VEGF-C level in the trial group (P<0.05), and a downward trend in TGF-β₁ and IL-6 levels in both groups (P<0.05); no significant difference was observed in TGF-β₁ and IL-6 levels between groups (P>0.05). At 3 months after operation, indocyanine green fluorescence (ICG) lymphography showed an anastomosis patency rate of 95.0% (38/40) in the trial group, significantly higher than the 68.4% (26/38) in the control group (P<0.05). The overall effectiveness was rated as significantly effective in 30 cases and effective in 15 cases in the trial group, while as significantly effective in 15 cases, effective in 15 cases, and ineffective in 8 cases in the control group. The difference between groups was significant (P<0.05). The incidence of complications showed no significant difference between trial group and control group (2.5% vs 7.9%, P>0.05). Conclusion The application of targeted multi-layer circular lymphatic drainage during the perioperative period of LVA is safe and effective. It significantly promotes lower limb circumference reduction and functional recovery without increasing the risk of complications.

Citation： WANG Xiaoyan, DU Jing, ZHANG Xiaomao, LU Shaoying, ZHAO Liang, CAI Hui. Effectiveness of lymphaticovenular anastomosis combined with perioperative targeted drainage in treatment of secondary lower limb lymphedema: a prospective randomized trial. Chinese Journal of Reparative and Reconstructive Surgery, 2026, 40(4): 637-642. doi: 10.7507/1002-1892.202511050 Copy

1.	鄧呈亮, 陳君哲, 肖順娥, 等. 基于算法淺談繼發性下肢淋巴水腫的外科整合治療. 中華燒傷與創面修復雜志, 2025, 41(6): 516-524.
2.	Kojimahara T, Tsukuura R. Changing the paradigm: Lymphovenous anastomosis in advanced stage lower extremity lymphedema. Plast Reconstr Surg, 2021, 148(2): 320e-321e.
3.	何挺, 王澤文, 張濤, 等. 外科技術治療肢體淋巴水腫的研究進展. 中國修復重建外科雜志, 2025, 39(2): 230-236.
4.	陳佳佳, 汪立, 韓凌華, 等. 應用手法淋巴引流綜合消腫療法治療肢體淋巴水腫的效果觀察. 組織工程與重建外科雜志, 2017, 13(6): 322-324, 327.
5.	李春月. 康復鍛煉方案對乳腺癌相關淋巴水腫術后患者的干預效果研究. 石家莊: 河北大學, 2016.
6.	Chang DW, Dayan J, Greene AK, et al. Surgical treatment of lymphedema: a systematic review and meta-analysis of controlled trials. Results of a consensus conference. Plast Reconstr Surg, 2021, 147(4): 975-993.
7.	Huang A, Chang DW. Lymphovenous bypass. Annals of Breast Surgery, 2024, 8: 10. doi: 10.21037/abs-23-6.
8.	Chang DW, Suami H, Skoracki R. A prospective analysis of 100 consecutive lymphovenous bypass cases for treatment of extremity lymphedema. Plast Reconstr Surg, 2013, 132(5): 1305-1314.
9.	蘇彩艷. 乳腺癌術后上肢淋巴水腫治療的研究進展. 臨床醫學進展, 2024, 14(11): 1404-1413.
10.	謝興斌, 羅力生, 郝廷智, 等. 顯微淋巴管靜脈吻合術10例報告. 第一軍醫大學學報, 1983, 3(2): 129-131.
11.	龔文靜, 呂麗麗, 王御震. 共享決策護理模式在下肢淋巴水腫患者綜合消腫治療維持期中的應用效果觀察. 中西醫結合護理, 2022, 8(8): 13-18.
12.	劉媛媛, 劉高明, 葉沙, 等. 基于新型手法淋巴引流的綜合消腫療法在123例乳腺癌相關淋巴水腫病人中的應用. 全科護理, 2025, 23(5): 853-857.
13.	Ingianni G, Holzmann T. Clinical experiences in the use of lymphovenous anastomoses in secondary lymphedema. Handchir Mikrochir Plast Chir, 1985, 17(1): 43-46.
14.	Ma J, Wang H, Li Y, et al. Effectiveness of isometric muscle training combined with manual lymphatic drainage on secondary lower extremity lymphedema following gynecologic cancer surgery. Front Bioeng Biotechnol, 2025, 13: 1568003. doi: 10.3389/fbioe.2025.1568003.
15.	Suzuki Y, Sakuma H, Ihara J, et al. Proximal ligation after the side-to-end anastomosis recovery technique for lymphaticovenous anastomosis. Arch Plast Surg, 2019, 46(4): 344-349.
16.	Wang C, Li B, Zhong Z, et al. The “Overlapping” lymphaticovenous anastomosis: an overlapped end-to-end anastomosis supermicrosurgical technique. BMC Surg, 2024, 24(1): 277. doi: 10.1186/s12893-024-02568-z.
17.	符曉陽, 翟水亭, 秦亞飛, 等. 淋巴靜脈吻合術治療繼發性淋巴水腫臨床療效分析. 中華實用診斷與治療雜志, 2023, 37(12): 1241-1244.
18.	Ciudad P, Bustos SS, Forte AJ, et al. Manual lymphatic drainage guided by real-time indocyanine green lymphography in breast cancer-related lymphedema. Arch Plast Surg, 2021, 48(2): 239-240.
19.	Seki Y, Kajikawa A. Fundamental and essential techniques for supermicrosurgical lymphaticovenular anastomosis: the art of Isao Koshima’s supermicrosurgery. Plast Aesthet Res, 2021, 8: 44. doi: 10.20517/2347-9264.2021.74.
20.	Campisi C, Davini D, Bellini C, et al. Lymphatic microsurgery for the treatment of lymphedema. Microsurgery, 2006, 26(1): 65-69.
21.	陳宗燦, 陳君哲, 王媛媛, 等. 基于旋髂淺動脈穿支的血管化淋巴結移植聯合淋巴管靜脈吻合術及脂肪抽吸術一期治療乳腺癌術后上肢淋巴水腫. 中國修復重建外科雜志, 2025, 39(9): 1114-1121.
22.	簡揚, 鄧呈亮, 魏在榮. 基于血管化淋巴結移植的淋巴水腫外科聯合治療研究進展. 中國修復重建外科雜志, 2023, 37(2): 240-246.
23.	陳君哲, 鄧呈亮. 干細胞治療淋巴水腫的基礎及臨床應用研究進展. 中國修復重建外科雜志, 2024, 38(1): 99-106.
24.	Hahn BA, Kleeven A, Richir MC, et al. Objectifying clinical outcomes after lymphaticovenous anastomosis and vascularized lymph node transfer in the treatment of extremity lymphedema: a systematic review and meta-analysis. Microsurgery, 2025, 45(3): e70050. doi: 10.1002/micr.70050.
25.	陳偉健, 劉高明, 劉彬, 等. 淋巴管靜脈吻合術聯合綜合消腫治療下肢乳糜返流性淋巴水腫1例. 中華顯微外科雜志, 2025, 48(6): 695-699.
26.	孟英濤, 孔榮華, 王榮娟, 等. 肢體氣壓治療聯合徒手淋巴引流干預乳腺癌患者上肢淋巴水腫的研究. 中國預防醫學雜志, 2021, 22(6): 471-473.
27.	馬志強, 范軍朝, 王文勝, 等. 氣壓泵聯合微波治療對乳腺癌改良根治術后上肢淋巴水腫的預防效果. 中國普外基礎與臨床雜志, 2018, 25(2): 191-196.
28.	周劍國, 胡學慶, 曹衛剛, 等. 人血管內皮生長因子-C基因治療淋巴水腫的實驗研究. 中華整形外科雜志, 2007, 23(6): 519-521.
29.	Hossain L, Gomes KP, Yang X, et al. Vascular endothelial growth factor C (VEGF-C) sensitizes lymphatic endothelial cells to oxidative-stress-induced apoptosis through DNA damage and mitochondrial dysfunction: implications for lymphedema. Int J Mol Sci, 2024, 25(14): 7828. doi: 10.3390/ijms25147828.

1. 鄧呈亮, 陳君哲, 肖順娥, 等. 基于算法淺談繼發性下肢淋巴水腫的外科整合治療. 中華燒傷與創面修復雜志, 2025, 41(6): 516-524.
2. Kojimahara T, Tsukuura R. Changing the paradigm: Lymphovenous anastomosis in advanced stage lower extremity lymphedema. Plast Reconstr Surg, 2021, 148(2): 320e-321e.
3. 何挺, 王澤文, 張濤, 等. 外科技術治療肢體淋巴水腫的研究進展. 中國修復重建外科雜志, 2025, 39(2): 230-236.
4. 陳佳佳, 汪立, 韓凌華, 等. 應用手法淋巴引流綜合消腫療法治療肢體淋巴水腫的效果觀察. 組織工程與重建外科雜志, 2017, 13(6): 322-324, 327.
5. 李春月. 康復鍛煉方案對乳腺癌相關淋巴水腫術后患者的干預效果研究. 石家莊: 河北大學, 2016.
6. Chang DW, Dayan J, Greene AK, et al. Surgical treatment of lymphedema: a systematic review and meta-analysis of controlled trials. Results of a consensus conference. Plast Reconstr Surg, 2021, 147(4): 975-993.
7. Huang A, Chang DW. Lymphovenous bypass. Annals of Breast Surgery, 2024, 8: 10. doi: 10.21037/abs-23-6.
8. Chang DW, Suami H, Skoracki R. A prospective analysis of 100 consecutive lymphovenous bypass cases for treatment of extremity lymphedema. Plast Reconstr Surg, 2013, 132(5): 1305-1314.
9. 蘇彩艷. 乳腺癌術后上肢淋巴水腫治療的研究進展. 臨床醫學進展, 2024, 14(11): 1404-1413.
10. 謝興斌, 羅力生, 郝廷智, 等. 顯微淋巴管靜脈吻合術10例報告. 第一軍醫大學學報, 1983, 3(2): 129-131.
11. 龔文靜, 呂麗麗, 王御震. 共享決策護理模式在下肢淋巴水腫患者綜合消腫治療維持期中的應用效果觀察. 中西醫結合護理, 2022, 8(8): 13-18.
12. 劉媛媛, 劉高明, 葉沙, 等. 基于新型手法淋巴引流的綜合消腫療法在123例乳腺癌相關淋巴水腫病人中的應用. 全科護理, 2025, 23(5): 853-857.
13. Ingianni G, Holzmann T. Clinical experiences in the use of lymphovenous anastomoses in secondary lymphedema. Handchir Mikrochir Plast Chir, 1985, 17(1): 43-46.
14. Ma J, Wang H, Li Y, et al. Effectiveness of isometric muscle training combined with manual lymphatic drainage on secondary lower extremity lymphedema following gynecologic cancer surgery. Front Bioeng Biotechnol, 2025, 13: 1568003. doi: 10.3389/fbioe.2025.1568003.
15. Suzuki Y, Sakuma H, Ihara J, et al. Proximal ligation after the side-to-end anastomosis recovery technique for lymphaticovenous anastomosis. Arch Plast Surg, 2019, 46(4): 344-349.
16. Wang C, Li B, Zhong Z, et al. The “Overlapping” lymphaticovenous anastomosis: an overlapped end-to-end anastomosis supermicrosurgical technique. BMC Surg, 2024, 24(1): 277. doi: 10.1186/s12893-024-02568-z.
17. 符曉陽, 翟水亭, 秦亞飛, 等. 淋巴靜脈吻合術治療繼發性淋巴水腫臨床療效分析. 中華實用診斷與治療雜志, 2023, 37(12): 1241-1244.
18. Ciudad P, Bustos SS, Forte AJ, et al. Manual lymphatic drainage guided by real-time indocyanine green lymphography in breast cancer-related lymphedema. Arch Plast Surg, 2021, 48(2): 239-240.
19. Seki Y, Kajikawa A. Fundamental and essential techniques for supermicrosurgical lymphaticovenular anastomosis: the art of Isao Koshima’s supermicrosurgery. Plast Aesthet Res, 2021, 8: 44. doi: 10.20517/2347-9264.2021.74.
20. Campisi C, Davini D, Bellini C, et al. Lymphatic microsurgery for the treatment of lymphedema. Microsurgery, 2006, 26(1): 65-69.
21. 陳宗燦, 陳君哲, 王媛媛, 等. 基于旋髂淺動脈穿支的血管化淋巴結移植聯合淋巴管靜脈吻合術及脂肪抽吸術一期治療乳腺癌術后上肢淋巴水腫. 中國修復重建外科雜志, 2025, 39(9): 1114-1121.
22. 簡揚, 鄧呈亮, 魏在榮. 基于血管化淋巴結移植的淋巴水腫外科聯合治療研究進展. 中國修復重建外科雜志, 2023, 37(2): 240-246.
23. 陳君哲, 鄧呈亮. 干細胞治療淋巴水腫的基礎及臨床應用研究進展. 中國修復重建外科雜志, 2024, 38(1): 99-106.
24. Hahn BA, Kleeven A, Richir MC, et al. Objectifying clinical outcomes after lymphaticovenous anastomosis and vascularized lymph node transfer in the treatment of extremity lymphedema: a systematic review and meta-analysis. Microsurgery, 2025, 45(3): e70050. doi: 10.1002/micr.70050.
25. 陳偉健, 劉高明, 劉彬, 等. 淋巴管靜脈吻合術聯合綜合消腫治療下肢乳糜返流性淋巴水腫1例. 中華顯微外科雜志, 2025, 48(6): 695-699.
26. 孟英濤, 孔榮華, 王榮娟, 等. 肢體氣壓治療聯合徒手淋巴引流干預乳腺癌患者上肢淋巴水腫的研究. 中國預防醫學雜志, 2021, 22(6): 471-473.
27. 馬志強, 范軍朝, 王文勝, 等. 氣壓泵聯合微波治療對乳腺癌改良根治術后上肢淋巴水腫的預防效果. 中國普外基礎與臨床雜志, 2018, 25(2): 191-196.
28. 周劍國, 胡學慶, 曹衛剛, 等. 人血管內皮生長因子-C基因治療淋巴水腫的實驗研究. 中華整形外科雜志, 2007, 23(6): 519-521.
29. Hossain L, Gomes KP, Yang X, et al. Vascular endothelial growth factor C (VEGF-C) sensitizes lymphatic endothelial cells to oxidative-stress-induced apoptosis through DNA damage and mitochondrial dysfunction: implications for lymphedema. Int J Mol Sci, 2024, 25(14): 7828. doi: 10.3390/ijms25147828.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of lymphaticovenular anastomosis combined with perioperative targeted drainage in treatment of secondary lower limb lymphedema: a prospective randomized trial

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