plasurВопросы реконструктивной и пластической хирургииIssues of Reconstructive and Plastic Surgery1814-1471АНО "НИИ микрохирургии"10.52581/1814-1471/94/08plasur-392Research ArticleНОВЫЕ ТЕХНОЛОГИИNEW TECHNOLOGIESВысокие хирургические технологии профилактики и лечения лимфореи и лимфедемы конечностей после аксиллярной и паховой лимфаденэктомии (обзор литературы)Advanced surgical technologies of lymphorrhea and limbs lymphedema prevention after axillary and inguinal lymph node dissection (literature review)https://orcid.org/0000-0001-6381-1327БашировС. Р.BashirovS. R.

Сергей Рафаэльевич Баширов, д-р мед. наук, доцент, зав. кафедрой

кафедра общей хирургии

634050; ул. Московский тракт, д. 2; Томск

Sergey R. Bashirov, Dr. Med. sci., Associate Professor, head of the Department

Department of General Surgery

634050; 2, Moskovsky trakt st.; Tomsk

bars-tomsk@rambler.ruhttps://orcid.org/0009-0008-6802-8591БарашковаА. А.BarashkovaA. A.

Анастасия Александровна Барашкова, студентка 5-го курса, лаборант

лечебный факультет; кафедра общей хирургии

634050; ул. Московский тракт, д. 2; Томск

Anastasia A. Barashkova, 5th year student, laboratory assistant

Medical faculty; Department of General Surgery

634050; 2, Moskovsky Trakt st.; Tomsk

barashkova_anastasia@mail.ruhttps://orcid.org/0009-0004-7992-9556ВасильеваЕ. А.VasilievaE. A.

Елизавета Алексеевна Васильева, врач-онколог, аспирант

кафедра общей хирургии

634069; ул. Ивана Черных, д. 98б; 634050; ул. Московский тракт, д. 2; Томск

Elizaveta A. Vasilyeva, oncologist, postgraduate student

Department of General Surgery

634069; 98б, Ivan Chernykh st.; 634050; 2, Moskovsky Trakt st.; Tomsk

elizaveta.liza29@mail.ruhttps://orcid.org/0000-0002-1973-8983ЗыковаМ. В.ZykovaM. V.

Мария Владимировна Зыкова, д-р фарм. наук, доцент, зав. кафедрой, старший научный сотрудник

кафедра химии; Центральная научно-исследовательская лаборатория

634050; ул. Московский тракт, д. 2; Томск

Maria V. Zykova, Dr. Pharm. sci., Associate Professor, head of the Department, Senior Researcher

Department of Chemistry; Central Research Laboratory

634050; 2, Moskovsky Trakt st.; Tomsk

zykova.mv@ssmu.ruhttps://orcid.org/0000-0001-9348-4945ИвановВ. В.IvanovV. V.

Владимир Владимирович Иванов, канд. биол. наук, руководитель центра

Центральная научно-исследовательская лаборатория; центр доклинических исследований

634050; ул. Московский тракт, д. 2; Томск

Vladimir V. Ivanov, Cand. Biol. sci., head of Center

Central Research Laboratory; Preclinical Research Center

634050; 2, Moskovsky Trakt st.; Tomsk

ivanovvv1953@gmail.comhttps://orcid.org/0000-0003-4844-9803АржаникМ. Б.ArzhanikM. B.

Марина Борисовна Аржаник, канд. пед. наук, доцент

кафедра медицинской и биологической кибернетики

634050; ул. Московский тракт, д. 2; Томск

Marina B. Arzhanik, Cand. Ped. sci., Associate Professor

Department of Medical and Biological Cybernetics

634050; 2, Moskovsky Trakt st.; Tomsk

arzh_m@mail.ruhttps://orcid.org/0009-0000-7214-2452СтрежневаА. А.StrezhnevaA. A.

Алина Александровна Стрежнева, студентка 6-го курса

лечебный факультет

634050; ул. Московский тракт, д. 2; Томск

Alina A. Strezhneva, 6th year student

634050; 2, Moskovsky Trakt st.; Tomsk

alstrezhneva@yandex.ruhttps://orcid.org/0009-0009-5022-5244БородинаС. В.BorodinaS. V.

Светлана Владимировна Бородина, ветеринарный врач

Центральная научно-исследовательская лаборатория; центр доклинических исследований

634050; ул. Московский тракт, д. 2; Томск

Svetlana V. Borodina, veterinarian

Central Research Laboratory; Preclinical Research Center

634050; 2, Moskovsky Trakt st.; Tomsk

borodina.sv@ssmu.ruСибирский государственный медицинский университетРоссияSiberian State Medical UniversityRussian FederationСибирский государственный медицинский университет; Томский областной онкологический диспансерРоссияSiberian State Medical University; Tomsk Regional Oncology CenterRussian Federation2025281020252836676Copyright © Баширов С.Р., Барашкова А.А., Васильева Е.А., Зыкова М.В., Иванов В.В., Аржаник М.Б., Стрежнева А.А., Бородина С.В., 20252025Баширов С.Р., Барашкова А.А., Васильева Е.А., Зыкова М.В., Иванов В.В., Аржаник М.Б., Стрежнева А.А., Бородина С.В.Bashirov S.R., Barashkova A.A., Vasilieva E.A., Zykova M.V., Ivanov V.V., Arzhanik M.B., Strezhneva A.A., Borodina S.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://plasur.elpub.ru/jour/article/view/392

   Выполнение радикальных операций с аксиллярной и паховой лимфаденэктомией сопряжено с развитием лимфореи и лимфедемы конечностей, которые без должной профилактики и лечения приводят к инвалидизации и ухудшению качества жизни абсолютного большинства оперированных больных. В статье проанализирована эффективность высокотехнологичных оперативных вмешательств с использованием эндоскопической аппаратуры, робототехники и реконструктивной микрохирургии в плане профилактики лимфореи и лимфедемы конечностей после аксиллярной и паховой лимфаденэктомии. Выполнен поиск исследований в открытых базах данных PubMed и Google Scholar. Проанализированы полнотекстовые публикации на русском и английском языках за последние 15 лет, содержащие информацию об использовании эндоскопических, роботизированных и микрохирургических технологий паховой и аксиллярной лимфаденэктомии. Представление полученных результатов в виде диаграмм производилось с помощью программы MS Office Excel 2019. Частота лимфореи после эндоскопической аксиллярной лимфаденэктомии варьирует в пределах от 3,1 до 97,6 %, после видеоэндоскопической паховой лимфаденэктомии – 0–30,7 %, лимфедемы – 0–19,0 %. Лимфорея после роботической паховой лимфаденэктомии встречается с частотой от 0–29,4 %, лимфедема – 0–27,3 %. Частота лимфореи после роботизированной мастэктомии с сохранением соска и реконструкцией молочной железы наиболее разнородная – от 0 до 94,7 %. Эффективность лимфовенозных анастомозов отмечена у 87,5–100 % больных лимфедемой нижних конечностей, у 80,7–93,3 % – лимфедемой верхних конечностей. Эффективность лимфонодуловенозных анастомозов отмечена у 70,6–100 % больных лимфедемой нижних конечностей. Эффективность пересадки васкуляризированных лимфоузлов отмечена у 66,7–100 % больных лимфедемой нижних конечностей и у 71,4–100 % – лимфедемой верхних конечностей. Таким образом, высокотехнологичные эндоскопические, роботизированные и микрохирургические операции, несмотря на неоднородную их эффективность, по большей части позитивно отразились на снижении частоты лимфореи и лимфедемы конечностей после аксиллярной и паховой лимфаденэктомии. Однако проведение таких вмешательств в один этап с лимфаденэктомией в большинстве случаев остается невозможным из-за высокой стоимости технологичной аппаратуры и расходных материалов, а также недостаточной квалификации специалистов. Поэтому поиск совершенных и в то же время доступных и воспроизводимых методов профилактики лимфореи и лимфедемы конечностей после лимфаденэктомии остается актуальной проблемой.

   Radical axillary and inguinal lymphadenectomies are associated with lymphorrhea and limbs lymphedema, which lead to disability and life quality decrease of the absolute majority of operated patients in case of no proper prevention and treatment.

   Purpose of the study

   Purpose of the study: to analyze the effectiveness of advanced technologies that use endoscopic and robotic equipment, reconstructive microsurgery in terms of preventing lymphorrhea and lymphedema after axillary and inguinal lymphadenectomy.

   The literature was searched using PubMed and Google Scholar electronic databases in accordance with keywords. Full-text publications in Russian and English over the past 15 years, containing information about the use of endoscopic, robotic and microsurgical technologies for inguinal and axillary lymphadenectomy, were analyzed. The diagrams were created using MS Office Excel 2019. The incidence of lymphorrhea after endoscopic axillary lymph node dissection (EALND) ranges from 3.1 to 94.7 %. The incidence of lymphorrhea after video-endoscopic inguinal lymphadenectomy (VEIL) ranges from 0 to 30.7 %, lymphedema – from 0 to 19.0 %. The incidence of lymphorrhea after robotic-assisted video-endoscopic inguinal lymphadenectomy (RAVEIL) varies from 0 to 29.4 %, lymphedema – 0 to 27.3 %. The incidence of lymphorrhea after robotic nipple-sparing mastectomy with immediate robotic breast reconstruction (RNSM and IRBR) have the highest heterogeneity – from 0 to 94.7 %. The effectiveness of lymphaticovenous anastomoses (LVA) was noted in 87.5–100 % of patients with lower limb lymphedema, and in 80.7–93.3 % of patients with upper limb lymphedema. The effectiveness of lymph node to vein anastomoses (LNVA) was noted in 70.6–100 % of patients with lower limb lymphedema. The effectiveness of vascularized lymph node transplantation (VLNT) was noted in 66.7–100 % of patients with lower limb lymphedema, and in 71.4–100 % of patients with upper limb lymphedema.

   Conclusion

   Conclusion. Despite the heterogeneity of results, advanced endoscopic, robotic and microsurgical surgical techniques demonstrated a positive effect on reducing the incidence of lymphorrhea and extremities lymphedema after axillary and inguinal lymphadenectomy. However, their use simultaneously with lymphadenectomy remains impossible in the majority of cases due to the high cost and the lack of necessary equipment. Therefore, the search for more effective and at the same time accessible methods for lymphorrhea and lymphedema prevention after lymphadenectomy is vitally needed.

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The authors declare that there are no conflicts of interest present.