Objective:To evaluate the long-term efficacy of liposuction combined with lymphaticovenous anastomosis (LVA) in the treatment of secondary lymphedema in lower extremity and analyse the factors that affect therapeutic outcomes.Methods:A retrospective analysis was conducted on the clinical data of 172 patients who were treated in the Department of Lymphatic Surgery, Capital Medical University Affiliated Beijing Shijitan Hospital for secondary lymphedema in lower extremity, between January 2019 and December 2021. The cohort comprised 170 females and 2 males, with a median age of 55 years. The primary diseases were: 99 patients with cervical cancer, 47 with endometrial cancer, 1 with penile cacer and 25 with other malignant tumours. All patients received liposuction to aspirate subcutaneous adipose tissue and LVA anastomosis of the inguinal lymphatic vessels with the great saphenous vein and its branches. Postoperative follow-ups were performed at outpatient clinic, telephone interview and questionnaire survey to acquire immediate status of the patients at the time. Following variables were included the follow-up: gender, age, body mass index (BMI), duration, hypertension, diabetes, the type of primary disease, history of surgery, history of lymph node dissection, history of radiotherapy or chemotherapy, extracellular water ratio (ECW%) in the affected limb, preoperative history of erysipelas, preoperative percentage difference in circumference of bilateral proximal toes, dorsal feet, ankles, distal third of legs, middle legs, proximal third of legs, knees, distal third of thighs, mid thighs, proximal third of thighs and groins. Additional parameters included duration of liposuction, intraoperative blood loss, adipose tissue content, number of lymphatic vessels anastomosed in LVA, postoperative daily standing time, postoperative history of erysipelas, and usage of compression garment. Univariate and multivariate analyses were performed using SPSS 26.0 software, with P <0.05 considered statistically significant. Results:A complete remission was defined as less than 10.0% in the percentage of bilateral limb volume difference during follow-up. There were 112 patients with complete remission. After excluded confounding factors through univariate analysis, multivariate analysis had revealed following independent risk factors: ECW% of affected limb ( P<0.01), postoperative standing duration >6 hours/day ( P=0.021), postoperative history of erysipelas ( P=0.016), regular use of compression garment ( P=0.013), and percentage difference of circumference at bilateral proximal toes ( P=0.038). Among the remaining 60 patients, 32 patients achieved effective remission which was defined as less than 20.0% in the swelling volume expansion ratio. Conclusion:Liposuction combined with LVA can relieve secondary lymphedema of lower extremity for majority of patients. ECW% of affected limb, postoperative standing duration >6 hours/day, postoperative history of erysipelas, irregular use of elastic socks, and percentage difference in circumference at bilateral proximal toes are the independent risk factors that affect the prognosis.

Objective:To explore the clinical characteristics, diagnosis, and treatment of chylous pleural effusion caused by liver cirrhosis.Methods:The clinical data of 19 cases of liver cirrhosis complicated with chylous pleural effusion admitted at Department of Lymphatic Surgery, Beijing Shijitan Hospital from Jun 2013 to Oct 2022 was retrospectively analyzed.Results:There were 12 males (63.2%) and 7 females (36.8%).Ten cases (52.6%) had right chylothorax, and 9 cases (47.4%) had bilateral chylothorax; Seventeen cases (89.5%) had concurrent ascites. Chest fluid examination: 3 cases were milky white (16%), 10 cases were yellow white (53%), 4 cases were orange yellow (21%), and 2 cases were pink (10%).There were 2 cases of exudate and 17 cases of transudate. By radionuclide lymphatic imaging, 9 cases showed increased radiation in the right chest cavity; One case showed increased radiation in the left chest cavity; Five cases showed bilateral chest radiation elevation. By lymphangiography,11 cases showed complete visualization of the thoracic duct, of which 10 cases showed obstruction at the outlet of the thoracic duct. The 10 patients underwent surgical treatment for the release of adhesions at the end of the thoracic duct, and the postoperative result was good. Six patients died during follow-up.Conclusions:Cirrhosis combined with chylous pleural effusion is rare in clinical practice and prognosis is poor. The laboratory examination of pleural effusion is an important basis for determining chylous pleural effusion. The lysis of adhesions at the end of the thoracic duct has a certain therapeutic effect on patients with lymphangiography indicating thoracic duct outlet obstruction.

Objective:To explore the clinical characteristics, diagnosis, and treatment of chylous pleural effusion caused by liver cirrhosis.Methods:The clinical data of 19 cases of liver cirrhosis complicated with chylous pleural effusion admitted at Department of Lymphatic Surgery, Beijing Shijitan Hospital from Jun 2013 to Oct 2022 was retrospectively analyzed.Results:There were 12 males (63.2%) and 7 females (36.8%).Ten cases (52.6%) had right chylothorax, and 9 cases (47.4%) had bilateral chylothorax; Seventeen cases (89.5%) had concurrent ascites. Chest fluid examination: 3 cases were milky white (16%), 10 cases were yellow white (53%), 4 cases were orange yellow (21%), and 2 cases were pink (10%).There were 2 cases of exudate and 17 cases of transudate. By radionuclide lymphatic imaging, 9 cases showed increased radiation in the right chest cavity; One case showed increased radiation in the left chest cavity; Five cases showed bilateral chest radiation elevation. By lymphangiography,11 cases showed complete visualization of the thoracic duct, of which 10 cases showed obstruction at the outlet of the thoracic duct. The 10 patients underwent surgical treatment for the release of adhesions at the end of the thoracic duct, and the postoperative result was good. Six patients died during follow-up.Conclusions:Cirrhosis combined with chylous pleural effusion is rare in clinical practice and prognosis is poor. The laboratory examination of pleural effusion is an important basis for determining chylous pleural effusion. The lysis of adhesions at the end of the thoracic duct has a certain therapeutic effect on patients with lymphangiography indicating thoracic duct outlet obstruction.

Objective:To evaluate the long-term efficacy of liposuction combined with lymphaticovenous anastomosis (LVA) in the treatment of secondary lymphedema in lower extremity and analyse the factors that affect therapeutic outcomes.Methods:A retrospective analysis was conducted on the clinical data of 172 patients who were treated in the Department of Lymphatic Surgery, Capital Medical University Affiliated Beijing Shijitan Hospital for secondary lymphedema in lower extremity, between January 2019 and December 2021. The cohort comprised 170 females and 2 males, with a median age of 55 years. The primary diseases were: 99 patients with cervical cancer, 47 with endometrial cancer, 1 with penile cacer and 25 with other malignant tumours. All patients received liposuction to aspirate subcutaneous adipose tissue and LVA anastomosis of the inguinal lymphatic vessels with the great saphenous vein and its branches. Postoperative follow-ups were performed at outpatient clinic, telephone interview and questionnaire survey to acquire immediate status of the patients at the time. Following variables were included the follow-up: gender, age, body mass index (BMI), duration, hypertension, diabetes, the type of primary disease, history of surgery, history of lymph node dissection, history of radiotherapy or chemotherapy, extracellular water ratio (ECW%) in the affected limb, preoperative history of erysipelas, preoperative percentage difference in circumference of bilateral proximal toes, dorsal feet, ankles, distal third of legs, middle legs, proximal third of legs, knees, distal third of thighs, mid thighs, proximal third of thighs and groins. Additional parameters included duration of liposuction, intraoperative blood loss, adipose tissue content, number of lymphatic vessels anastomosed in LVA, postoperative daily standing time, postoperative history of erysipelas, and usage of compression garment. Univariate and multivariate analyses were performed using SPSS 26.0 software, with P <0.05 considered statistically significant. Results:A complete remission was defined as less than 10.0% in the percentage of bilateral limb volume difference during follow-up. There were 112 patients with complete remission. After excluded confounding factors through univariate analysis, multivariate analysis had revealed following independent risk factors: ECW% of affected limb ( P<0.01), postoperative standing duration >6 hours/day ( P=0.021), postoperative history of erysipelas ( P=0.016), regular use of compression garment ( P=0.013), and percentage difference of circumference at bilateral proximal toes ( P=0.038). Among the remaining 60 patients, 32 patients achieved effective remission which was defined as less than 20.0% in the swelling volume expansion ratio. Conclusion:Liposuction combined with LVA can relieve secondary lymphedema of lower extremity for majority of patients. ECW% of affected limb, postoperative standing duration >6 hours/day, postoperative history of erysipelas, irregular use of elastic socks, and percentage difference in circumference at bilateral proximal toes are the independent risk factors that affect the prognosis.

Objective:To explore the significance of multiple frequency bioelectrical impedance analysis (MFBIA) in the combined surgical treatment of breast cancer-related lymphedema (BCRL).Methods:A retrospective analysis was conducted on the clinical data of 30 patients with unilateral postoperative BCRL. The patients recieved staged liposuction and lymphaticovenular anastomosis (LVA) from April to October 2021 at the Department of Lymphatic Surgery in Beijing Shijitan Hospital, Capital Medical University. After LVA surgery, patients were followed-up by telephone and other means, and asked to come to the hospital at 1 year and 2 years, respectively. The circumference of each part of the upper limbs, the length of forearm and arm were measured, and the limb volume was calculated. MFBIA were also performed to record limb bioelectrical impedance, extracellular water(ECW), and extracellular water ratios (ECW/TBW). SPSS 21.0 was used for statistical analysis. Clinical data of the patients were analysed by One-way Repeated Measurement Anova to examine the changes in volume of the affected arms before and after surgery and the changes in values collected by MFBIA. Subsequently, differences in the volumes and values of MFBIA of the affected arms before and after surgery, and the ratios of the above were analysed by paired t-test to compare each pair, then followed by Pearson correlation test. P<0.05 was considered statistically significant. Results:After liposuction, the volume differences of affected and healthy arms were reduced from 1 147 ml ± 484 ml before surgery to 261 ml ± 304 ml after surgery, which achieved a significant reduction with statistical significance ( P<0.05). However, there were no significant changes in ECW or bioelectrical impedance at various frequencies (1-1 000 K) ( P>0.05). After LVA, the differences in volume of the affected and healthy arms further decreased to 17 ml±264 ml with statistical significance compared to that before surgery ( P<0.05), ECW decreased from 1.115 L ± 0.207 L to 0.937 L ± 0.164 L with statistical significance ( P<0.05), ECW/TBW decreased from 0.412 ± 0.008 to 0.405 ± 0.007 with statistical significance ( P<0.05), and the bioelectrical impedance at various frequencies was significantly increased with statistical significance ( P<0.05). After LVA, the difference in arm volume was positively correlated with the difference in ECW (correlation coefficient 0.602, P<0.05), positively correlated with the difference in Rate of ECW (correlation coefficient 0.560, P<0.05), and negatively correlated with the ratios of impedance at various frequencies (correlation coefficients 0.529-0.545, P<0.05). Conclusion:In the staged surgical treatment of BCRL, with the application of MFBIA, it is found that lymphatic liposuction removes the pathological adipose tissue of an arm, hence significantly reduces the volume of the affected arm. However, lymphatic stasis remains unrelieved, therefore without a significant reduction in arm oedema. After the second-stage LVA, the improvement of lymphatic return leads to the relief of arm oedema, and the volume of the affected arm approaches to that of the healthy side. MFBIA can be used for assessment of arm oedema.

Objective:To investigate the characteristics and diagnostic methods for the patients with primary lymphedema and interstitial lung disease, as well as the efficacy of thoracic duct or right lymphatic duct plasty.Methods:A retrospective study was performed on 13 patients who were treated for primary lymphedema in the Department of Lymphatic Surgery, Beijing Shijitan Hospital, Capital Medical University, from January 2018 to December 2022. All patients were confirmed with interstitial lung disease by high-resolution CT (HRCT) and then underwent thoracic duct or right lymphatic duct plasty surgery. The 13 patients in this study were 7 males and 6 females aged 7.3 (0.7-30.0) years old. Primary lymphedema was the first manifestation in all patients, with an average morbidity age at 1.0 (0-11.0) years old. The average time from the onset of lymphedema to the confirmed interstitial lung disease was 6.3 (0.3-19.0) years. All patients underwent thoracic duct or right lymphatic duct plasty for improvement of the lymphatic flow. In addition, 9 cases (69.2%) received a direct lymphangiography (DLG). In which, 4 cases (44.4%) received further treatment of ligation of the reflux branches, and 1 (11.1%) had the treatment plans changed, because a chylous reflux into the lung through a bronchomediastinal trunk was found from DLG, therefore a ligation of the abnormal reflux branches was performed and a life-long strict low-fat diet was required. Postoperative follow-ups for evaluation of the improvements of lymphedema and pulmonary lymphatic flow were carried out by visit of outpatient clinic or via telephone interviews.Results:All patients recovered well after surgery with an average follow-up time of 47.5 (19.0-68.0) months. Lymphedema was stable in 2 cases (15.4%) and relieved in 11 cases (84.6%). Ten cases (76.9%) had completed the postoperative HRCT reviews and 9 (90.0%) were found with significant improvement in the interstitial lung disease.Conclusion:The interstitial lung disease found during the examination of patients with primary lymphedema can be explained with a lymphatic flow disorder. DLG can identify the cause and make to guide the treatment. Thoracic duct or right lymphatic duct plasty can effectively improve both of the symptom of lymphedema and interstitial lung disease.

Objective:To investigate the clinical features of primary intestinal lymphangiectasia (PIL).Methods:This study was a retrospective case series study. Fifty consecutive patients diagnosed with PIL in Department of Lymphatic Surgery, Beijing Shijitan Hospital, Capital Medical University from March 2019 to March 2021 were included and their clinical data was retrospectively reviewed. There were 20 males and 30 females included, with an age of ( M(IQR)) 14 (40) years (range:0 to 67 years). No patient had the family history. There were 26 children, including 9 males and 17 females, aged 0 (7) years (range:0 to 14 years). There were 24 adults, including 11 males and 13 females, aged 40 (26) years (range:20 to 67 years). The clinical manifestations and the results of laboratory examinations, gastrointestinal endoscopy, 99Tc m-labeled human albumin ( 99Tc m-HSA) scintigraphy, 99Tc m-DX scintigraphy, direct lymphangiography (DLG), histopathology, diet treatment, surgical intervention, and clinical symptom remission at discharge were collected. Comparisons between groups were performed using independent samples t-test, Mann-Whitney U test, or χ2 test. Results:Among the 50 cases of PIL, the main manifestations were edema (86.0%), diarrhea (76.0%), and abdominal effusion (48.0%). Lymphedema (36.0%) and chylous ascites (18.0%) were not rare in PIL patients. In 99Tc m-HAS scintigraphy, 95.9% (47/49) cases showed signs of intestinal protein loss, and 91.7% (44/48) ceses showed positive findings in 99Tc m-DX scintigraphy. In DLG, 97.8% (45/46) cases showed signs of thoracic duct obstruction, 82.6% (38/46) cases showed retroperitoneal lymphatic hyperplasia, and 23.9% (11/46) cases showed backflow of contrast agent into intestine. No significant difference was seen in gender, course of disease, clinical manifestation, serum level of albumin or globulin, lymphocyte count, positive rate of fecal occult blood and prevalence of lymphedema between adults and children (all P>0.05). Conclusions:The clinical presentations of PIL between children and adults had no significant difference. The diagnosis of PIL should be made according to clinical manifestation, 99Tc m-HAS scintigraphy, 99Tc m-DX scintigraphy, DLG, gastrointestinal endoscopy and pathological findings.

Objective:To investigate the characteristics, diagnosis and therapeutic effect of acquired lymphangiectasia of the vulva (ALV).Methods:A retrospective analysis of clinicopathological and follow-up data was conducted on the patients treated in Capital Medical University Affiliated Beijing Shijitan Hospital due to female ALV from July 2009 to July 2023. The patients who completed the staged operations [partial labiectomy and reconstruction + thoracic ductplasty and (or) perineal lymphovenous anastomosis] were included in the study and followed up. The improvement of perineal swelling, blister range, fluid leakage volume and frequency were evaluated through outpatient visits by the symptom rating scale of ALV (hereinafter referred to as the symptom rating scale) before and after surgery.Results:A total of 48 patients were treated due to ALV from July 2009 to July 2023, of which 98% (47/48) were postoperative pelvic malignant tumors and 94% (45/48) had a history of radiotherapy. A total of 10 patients with ALV who completed the staged operations were included in this study. (1) Clinical characteristics and diagnosis: 10 patients had a median age of 60 years old (50, 63 years old ). The median duration from cervical cancer surgery and radiation therapy to vulvar swelling was 1.5 years (0.0, 2.0 years), and the median duration from vulvar swelling to blister formation and leakage was 0.0 years (0.0, 4.8 years). Seven patients (7/10) had a history of recurrent erysipelas; 7 patients (7/10) had the most severe symptom (widespread blisters, persistent fluid leakage, and large amount of fluid leakage); noncontrast magnetic resonance lymphography (NCMRL) showed edema signals in the perineal region of all the patients, and increase of agent in the perineal region was observed in lymphoscintigram (LS). (2) Surgical treatment and postoperative pathological examination: of the 10 ALV patients who completed staged surgical treatment, 6 cases (6/10) were diagnosed with thoracic duct outlet obstruction and underwent thoracic ductplasty and partial labiectomy and reconstruction. Perineal lymphovenous anastomosis and partial labiectomy and reconstruction were performed in 4 cases (4/10) without thoracic duct outlet obstruction. Postoperative routine pathological examination of 10 patients (10/10) showed dermal papilla lymphangiectasia. Immunohistochemical tests were performed on 5 patients, all of which were positive for D2-40 and negative for CD 34. (3) Efficacy: 8 patients completed the postoperative follow-up, and the median follow-up time was 31.0 months (17.5, 78.3 months). The perineal swelling and the blister fluid leakage were all significantly improved after the staged operations. All indexes of the symptom rating scale, including the degree of perineal swelling, blister range, fluid leakage volume and frequency, were significantly improved in 8 follow-up patients, and 3 (3/8) of them were cured; the median symptom score decreased significantly from 11.0 before surgery to 3.0 after surgery ( P<0.001). The incidence of erysipelas was significantly reduced from 7/10 before surgery to 2/8 after surgery ( P=0.035). Conclusions:The main causes of female ALV are pelvic tumor surgery and radiotherapy. The clinical diagnosis is made from relevant medical history, clinical manifestations, LS and magnetic resonance imaging. The diagnosis is confirmed by histopathological findings. Pathological results show lymphangiectasia in the dermal papilla, and immunohistochemical staining show positive for D2-40 and negative for CD 34. The effect of staged surgery on ALV is remarkable and even cured, and could effectively reduce the incidence of erysipelas.

Objective:To investigate the clinical features of primary intestinal lymphangiectasia (PIL).Methods:This study was a retrospective case series study. Fifty consecutive patients diagnosed with PIL in Department of Lymphatic Surgery, Beijing Shijitan Hospital, Capital Medical University from March 2019 to March 2021 were included and their clinical data was retrospectively reviewed. There were 20 males and 30 females included, with an age of ( M(IQR)) 14 (40) years (range:0 to 67 years). No patient had the family history. There were 26 children, including 9 males and 17 females, aged 0 (7) years (range:0 to 14 years). There were 24 adults, including 11 males and 13 females, aged 40 (26) years (range:20 to 67 years). The clinical manifestations and the results of laboratory examinations, gastrointestinal endoscopy, 99Tc m-labeled human albumin ( 99Tc m-HSA) scintigraphy, 99Tc m-DX scintigraphy, direct lymphangiography (DLG), histopathology, diet treatment, surgical intervention, and clinical symptom remission at discharge were collected. Comparisons between groups were performed using independent samples t-test, Mann-Whitney U test, or χ2 test. Results:Among the 50 cases of PIL, the main manifestations were edema (86.0%), diarrhea (76.0%), and abdominal effusion (48.0%). Lymphedema (36.0%) and chylous ascites (18.0%) were not rare in PIL patients. In 99Tc m-HAS scintigraphy, 95.9% (47/49) cases showed signs of intestinal protein loss, and 91.7% (44/48) ceses showed positive findings in 99Tc m-DX scintigraphy. In DLG, 97.8% (45/46) cases showed signs of thoracic duct obstruction, 82.6% (38/46) cases showed retroperitoneal lymphatic hyperplasia, and 23.9% (11/46) cases showed backflow of contrast agent into intestine. No significant difference was seen in gender, course of disease, clinical manifestation, serum level of albumin or globulin, lymphocyte count, positive rate of fecal occult blood and prevalence of lymphedema between adults and children (all P>0.05). Conclusions:The clinical presentations of PIL between children and adults had no significant difference. The diagnosis of PIL should be made according to clinical manifestation, 99Tc m-HAS scintigraphy, 99Tc m-DX scintigraphy, DLG, gastrointestinal endoscopy and pathological findings.

Central post-stroke pain (CPSP), a neuropathic pain syndrome occurring after a cerebrovascular accident, is characterized by pain or paraesthesia in the part of the body dominated by the area of the brain where blood vessels are injured. CPSP patients are often accompanied by anxiety, depression and other emotional disorders, which have a serious negative impact on patients' quality of life. However, the pathogenesis of CPSP has not been fully elucidated, the clinical diagnosis rate is not high, and the commonly used treatment methods are not effective. This article reviews the clinical features, epidemiology, pathogenesis and treatment of CPSP in order to provide reference for the elucidation of CPSP mechanism and effective treatment.