林口院區-淋巴水腫治療中心

簡介

林口長庚醫院顯微重建外科醫療團隊在國際整形外科界享有盛名,顯微淋巴結皮瓣移植手術更是領先國際,近年來成立全世界第一個淋巴水腫治療中心,協助患者改善淋巴水腫、恢復生活品質。

乳癌、子宮頸癌或其他婦癌切除之術後淋巴水腫,是指因手術切除淋巴結或放射線治療造成組織纖維化,而導致淋巴回流通道出現問題,淋巴液無法藉由淋巴系統回流至血液循環,造成高蛋白組織間液不正常堆積,引起上肢或下肢水腫。

本中心醫療特色是以-「顯微淋巴結皮瓣移植」至淋巴水腫患肢,移植的淋巴結就像抽水馬達,可抽取淹水地區的淋巴液,將淋巴液抽到靜脈系統,改善淋巴水腫。此手術技術領先國際先進國家,目前已完成超過百例顯微淋巴結皮瓣移植手術,手術成功率高達98%


服務特色

本中心擁有最完整的照護病房:顯微淋巴結皮瓣移植後,會轉至加護病房密集觀察皮瓣及血管狀況,隨時監測並提供整體性照護。此顯微重建加護病房特色,為亞洲第一個專為重建整形外科成立之照護單位,提供獨立專屬空間,維護病人隱私,並由一群訓練有素的整形外科醫師及護理人員負責照護,以確保手術能達到最大成功率,並提升照護品質。


治療對象

  1. 積極復健1年以上無效者
  2. 淋巴攝影﹝Lymphoscintigraphy﹞顯示淋巴循環阻塞
  3. 兩手臂圍相差10%,無合併腫瘤復發或遠處轉移

團隊陣容

顯微重建外科:鄭明輝醫師

乳房外科:周旭桓醫師

婦產科:李奇龍醫師

核子醫學科:林潔醫師

放射診斷科:朱松毓醫師、黃彥綾醫師、詹雯惠醫師

復健科:游東陽醫師、吳佩璇醫師

專科護理師:鄭美隨

復健師:連淑惠

個案管理師:林佳佑、林怡伶


淋巴水腫中心醫療團隊合照

本中心所提供的治療項目包括:先天性淋巴水腫、乳癌切除後上肢淋巴水腫、婦癌切除後下肢淋巴水腫。

上肢淋巴水腫

↑ 術前-右側乳癌切除、右手淋巴水腫

↑ 腹股溝淋巴結皮瓣移植到右手腕

術後20個月-手肘上改善78%,手肘下改善92%

 

↑ 術前-右側乳癌切除、右手淋巴水腫

↑ 腹股溝淋巴結皮瓣移植到右手肘內側

術後6個月-手肘上改善70.5%,手肘下改善53%

下肢淋巴水腫

術前-子宮頸癌術後右腳淋巴水腫

↑ 右頸部淋巴結皮瓣移植到右腳踝

術後17個月-膝上改善61.5%,膝下改善85%,足踝上改善53.3%

術後復健

本中心擁有完整且連續性醫療照護,淋巴水腫術後需執行復建治療,整形外科復健中心可提供個別性量身訂做壓力衣,患者在活動時需穿戴,避免肢體水腫。氣動性淋巴循環機,加壓按摩,促進淋巴回流。下肢淋巴水腫術後可騎固定式腳踏車,促進靜脈回流。復健運動可增加淋巴及靜脈回流,有事半功倍的效果。


術後追蹤成效

上下肢淋巴水腫會使受侵犯肢體腫脹、疼痛、組織纖維化甚至肢體活動受到限制,而患者會因為身體心像改變產生憂鬱及負向情緒,進而減少社交活動,使生活品質受影響。

顯微淋巴結皮瓣移植術後,平均追蹤2年,淋巴水腫改善程度可達60%以上,患者自覺肢體變軟變輕,活動變自如,改善日常生活不便,且恢復生活質量。
 

研究水準

目前上下肢淋巴水腫手術治療論文,共37篇發表在國際醫學期刊(SCI),其中有兩篇研究結果更是獲得國際醫學肯定,分別於2018年9月及2017年7月刊登在國際最頂尖的外科醫學期刊(Annals of Surgery),主題為「Validity of the Novel Taiwan Lymphoscintigraphy Staging and Correlation of Cheng LymphedemaGrading for Unilateral Extremity Lymphedema」及「Outcomes of Lymphedema Microsurgery for Breast Cancer-related Lymphedema With or Without Microvascular Breast Reconstruction」。

受邀撰寫英文淋巴水腫教科書章節,共16篇,並撰寫一本英文淋巴水腫教科書「Principles and Practice of Lymphedema Surgery」.,於2015年發行。

 

Dr. Cheng's Publications in Lymphedema Microsurgery

SCI paper: 37

  1. Vascularized groin lymph node transfer using the wrist as a recipient site for management of postmastectomy upper extremity lymphedema.
    Lin CH, Ali R, Chen SC, Wallace C, Chang YC, Chen HC, Cheng MH. Plast Reconstr Surg. 2009 Apr;123(4):1265-75. doi: 10.1097/PRS.0b013e31819e6529.
    https://www.ncbi.nlm.nih.gov/pubmed/19337095
  2. A novel approach to the treatment of lower extremity lymphedema by transferring a vascularized submental lymph node flap to the ankle.
    Cheng MH, Huang JJ, Nguyen DH, Saint-Cyr M, Zenn MR, Tan BK, Lee CL. Gynecol Oncol. 2012 Jul;126(1):93-8. doi: 10.1016/j.ygyno.2012.04.017. Epub 2012 Apr 17.
    https://www.ncbi.nlm.nih.gov/pubmed/22516659
  3. Vascularized groin lymph node flap transfer for postmastectomy upper limb lymphedema: flap anatomy, recipient sites, and outcomes.
    Cheng MH, Chen SC, Henry SL, Tan BK, Lin MC, Huang JJ.
    Plast Reconstr Surg. 2013 Jun;131(6):1286-98. doi: 10.1097/PRS.0b013e31828bd3b3
    https://www.ncbi.nlm.nih.gov/pubmed/19337095
    https://www.ncbi.nlm.nih.gov/pubmed/23714790
  4. Preplanning Vascularized Lymph Node Transfer with Duplex Ultrasonography: An Evaluation of 3 Donor Sites.
    Patel KM, Chu SY,  Huang JJ, Wu CW, Lin CY, Cheng MH.
    Plast Reconstr Surg Glob Open. 2014 Sep 8;2(8):e193. doi: 10.1097/GOX.0000000000000105. eCollection 2014 Aug.
    https://www.ncbi.nlm.nih.gov/pubmed/25426376
  5. The use of magnetic resonance angiography in vascularized groin lymph node transfer: an anatomic study.
    Dayan JH, Dayan E, Kagen A, Cheng MH, Sultan M, Samson W, Smith ML.
    J Reconstr Microsurg. 2014 Jan;30(1):41-5. doi: 10.1055/s-0033-1351668. Epub 2013 Sep 9.
    https://www.ncbi.nlm.nih.gov/pubmed/24019175
  6. The mechanism of vascularized lymph node transfer for lymphedema: natural lymphaticovenous drainage.
    Cheng MH, Huang JJ, Wu CW, Yang CY, Lin CY, Henry SL, Kolios L.
    Plast Reconstr Surg. 2014 Feb;133(2):192e-8e. doi: 10.1097/01.prs.0000437257.78327.5b.
    https://www.ncbi.nlm.nih.gov/pubmed/24469190
  7. Developing a Lower Limb Lymphedema Animal Model with Combined Lymphadenectomy and Low-dose Radiation.
    Yang CY, Nguyen DH, Wu CW, Fang YH, Chao KT, Patel KM, Cheng MH.
    Plast Reconstr Surg Glob Open. 2014 Apr 7;2(3):e121. doi: 10.1097/GOX.0000000000000064. eCollection 2014 Mar.
    https://www.ncbi.nlm.nih.gov/pubmed/25289315
  8. Vascularized lymph node flap transfer and lymphovenous anastomosis for klippel-trenaunay syndrome with congenital lymphedema.
    Qiu SS, Chen HY, Cheng MH.
    Plast Reconstr Surg Glob Open. 2014 Jul 9;2(6):e167. doi: 10.1097/GOX.0000000000000099. eCollection 2014 Jun.
    https://www.ncbi.nlm.nih.gov/pubmed/25289360
  9. From theory to evidence: long-term evaluation of the mechanism of action and flap integration of distal vascularized lymph node transfers.
    Patel KM, Lin CY, Cheng MH.
    J Reconstr Microsurg. 2015 Jan;31(1):26-30. doi: 10.1055/s-0034-1381957. Epub 2014 Aug 19.
    https://www.ncbi.nlm.nih.gov/pubmed/25137504
  10. Quantity of lymph nodes correlates with improvement in lymphatic drainage in treatment of hind limb lymphedema with lymph node flap transfer in rats.
    Nguyen DH, Chou PY, Hsieh YH, Momeni A, Fang YH, Patel KM, Yang CY, Cheng MH.
    Microsurgery. 2016 Mar;36(3):239-45. doi: 10.1002/micr.22388. Epub 2015 Feb 25.
    https://www.ncbi.nlm.nih.gov/pubmed/25715830
  11. Simultaneous Bilateral Submental Lymph Node Flaps for Lower Limb Lymphedema Post Leg Charles Procedure.
    Ito R, Lin MC, Cheng MH.
    Plast Reconstr Surg Glob Open. 2015 Sep 15;3(9):e513. doi: 10.1097/GOX.0000000000000489. eCollection 2015 Sep.
    https://www.ncbi.nlm.nih.gov/pubmed/26495226
  12. Successful treatment of early-stage lower extremity lymphedema with side-to-end lymphovenous anastomosis with indocyanine green lymphography assisted.
    Ito R, Wu CT, Lin MC, Cheng MH.
    Microsurgery. 2016 May;36(4):310-5. doi: 10.1002/micr.30010. Epub 2015 Dec 15.
    https://www.ncbi.nlm.nih.gov/pubmed/26666982
  13. Lymphedema surgery: Patient selection and an overview of surgical techniques.
    Allen RJ Jr, Cheng MH.
    J Surg Oncol. 2016 Jun;113(8):923-31. doi: 10.1002/jso.24170. Epub 2016 Feb 5. Review.
    https://www.ncbi.nlm.nih.gov/pubmed/26846615
  14. Surgical anatomy of the vascularized submental lymph node flap: Anatomic study of correlation of submental artery perforators and quantity of submental lymph node.
    Tzou CH, Meng S, Ines T, Reissig L, Pichler U, Steinbacher J, Pona I, Roka-Palkovits J, Rath T, Weninger WJ, Cheng MH.
    J Surg Oncol. 2017 Jan;115(1):54-59. doi: 10.1002/jso.24336. Epub 2016 Jun 23.
    https://www.ncbi.nlm.nih.gov/pubmed/27338566
  15. The 5th world symposium for lymphedema surgery-Recent updates in lymphedema surgery and setting up of a global knowledge exchange platform.
    Loh CY, Wu JC, Nguyen A, Dayan J, Smith M, Masia J, Chang D, Koshima I, Cheng MH.
    J Surg Oncol. 2017 Jan;115(1):6-12. doi: 10.1002/jso.24341. Epub 2016 Jun 28. Review.
    https://www.ncbi.nlm.nih.gov/pubmed/27353481
  16. The surgical anatomy of the supraclavicular lymph node flap: A basis for the free vascularized lymph node transfer.
    Steinbacher J, Tinhofer IE, Meng S, Reissig LF, Placheta E, Roka-Palkovits J, Rath T, Cheng MH, Weninger WJ, Tzou CH.
    J Surg Oncol. 2017 Jan;115(1):60-62. doi: 10.1002/jso.24346. Epub 2016 Jun 28.
    https://www.ncbi.nlm.nih.gov/pubmed/27353521
  17. The 5th World Symposium for Lymphedema Surgery.
    Cheng MH, Koshima I, Chang DW, Masia J.
    J Surg Oncol. 2017 Jan;115(1):5. doi: 10.1002/jso.24383. Epub 2016 Jul 29. No abstract available.
    https://www.ncbi.nlm.nih.gov/pubmed/27473624
  18. Platysma-sparing vascularized submental lymph node flap transfer for extremity lymphedema.
    Poccia I, Lin CY, Cheng MH.
    J Surg Oncol. 2017 Jan;115(1):48-53. doi: 10.1002/jso.24350. Epub 2017 Jan 6.
    https://www.ncbi.nlm.nih.gov/pubmed/28058777
  19. A prospective clinical assessment of anatomic variability of the submental vascularized lymph node flap.
    Cheng MH, Lin CY, Patel KM.
    J Surg Oncol. 2017 Jan;115(1):43-47. doi: 10.1002/jso.24487. Epub 2017 Jan 13.
    https://www.ncbi.nlm.nih.gov/pubmed/28083889
  20. Greater Omental Lymph Node Flap for Upper Limb Lymphedema with Lymph Nodes-depleted Patient.
    Chu YY, Allen RJ Jr, Wu TJ, Cheng MH.
    Plast Reconstr Surg Glob Open. 2017 Apr 25;5(4):e1288. doi: 10.1097/GOX.0000000000001288. eCollection 2017 Apr.
    https://www.ncbi.nlm.nih.gov/pubmed/28507857
  21. The surgical anatomy of the vascularized lateral thoracic artery lymph node flap-A cadaver study.
    Tinhofer IE, Meng S, Steinbacher J, Roka-Palkovits J, Györi E, Reissig LF, Cheng MH, Weninger WJ, Tzou CH.
    J Surg Oncol. 2017 Dec;116(8):1062-1068. doi: 10.1002/jso.24783. Epub 2017 Aug 7.
    https://www.ncbi.nlm.nih.gov/pubmed/28782246
  22. Visualization of Skin Perfusion by Indocyanine Green Fluorescence Angiography-A Feasibility Study.
    Steinbacher J, Yoshimatsu H, Meng S, Hamscha UM, Chan CS, Weninger WJ, Wu CT, Cheng MH, Tzou CH.
    Plast Reconstr Surg Glob Open. 2017 Sep 25;5(9):e1455. doi: 10.1097/GOX.0000000000001455. eCollection 2017 Sep.
    https://www.ncbi.nlm.nih.gov/pubmed/?term=Visualization+of+Skin+Perfusion+by+Indocyanine+Green+Fluorescence+Angiography-A+Feasibility+Study
  23. Vascularized lymph node transfer for treatment of extremity lymphedema: An overview of current controversies regarding donor sites, recipient sites and outcomes.
    Pappalardo M, Patel K, Cheng MH.
    J Surg Oncol. 2018 Jun;117(7):1420-1431. doi: 10.1002/jso.25034. Epub 2018 Mar 24. Review.
    https://www.ncbi.nlm.nih.gov/pubmed/29572824
  24. Vascularized Lymph Node Transfer for Lymphedema.
    Schaverien MV, Badash I, Patel KM, Selber JC, Cheng MH.
    Semin Plast Surg. 2018 Feb;32(1):28-35. doi: 10.1055/s-0038-1632401. Epub 2018 Apr 9.Review.
    https://www.ncbi.nlm.nih.gov/pubmed/29636651
  25. Accurate Prediction of Submental Lymph Nodes Using Magnetic Resonance Imaging for Lymphedema Surgery.
    Asuncion MO, Chu SY, Huang YL, Lin CY, Cheng MH.
    Plast Reconstr Surg Glob Open. 2018 Mar 23;6(3):e1691. doi: 10.1097/GOX.0000000000001691. eCollection 2018 Mar.
    https://www.ncbi.nlm.nih.gov/pubmed/29707451
  26. Critical Ischemia Time, Perfusion and Drainage Function of Vascularized Lymph Nodes.
    Yang CY, Ho OA, Cheng MH, Hsiao HY.
    Plast Reconstr Surg. 2018 Jun 12. doi: 10.1097/PRS.0000000000004673.
    https://www.ncbi.nlm.nih.gov/pubmed/29927833
  27. Correlation between Quantity of Transferred Lymph Nodes and Outcome in Vascularized Submental Lymph Node Flap Transfer for Lower Limb Lymphedema.
    Gustafsson J, Chu SY, Chan WH, Cheng MH.
    Plast Reconstr Surg. 2018 Jul 10. doi: 10.1097/PRS.0000000000004793.
    https://www.ncbi.nlm.nih.gov/pubmed/30020232
  28. Acoustic Radiation Force Impulse Elastography: Tissue Stiffness Measurement in Limb Lymphedema.
    Chan WH, Huang YL, Lin C, Lin CY, Cheng MH, Chu SY.
    Radiology. 2018 Aug 14:172869. doi: 10.1148/radiol.2018172869.
    https://www.ncbi.nlm.nih.gov/pubmed/30106341
  29. Lymph node transplantation for the treatment of lymphedema.
    Gould DJ, Mehrara BJ, Neligan P, Cheng MH, Patel KM.
    J Surg Oncol. 2018 Aug 21. doi: 10.1002/jso.25180.
    https://www.ncbi.nlm.nih.gov/pubmed/30129675
  30. Evaluation of the Effectiveness of Vascularized Lymph Node Transfer for Extremity Lymphedema Using CT Volumetric and Circumferential Difference
    Ho OA, Lin CY, Cheng MH.
    Plast Reconstr Surg Glob Open. 2018
  31. Lymphedema and Concomitant Vascular Lesions in the Extremity: Comprehensive Evaluation, Management Strategy, and Outcomes
    Neil, Cheng MH.
    J Surg Oncol. 2018
  32. Successful Outcomes of Vascularized Lymph Node Transfer and Lymphovenous Anastomosis for Treatment of Primary Lymphedema
    Charles, Cheng MH.
    Plast Reconstr Surg Glob Open. 2018
  33. The Submental versus Groin Vascularized Lymph Node Transfer Flaps: A Head-to-Head Comparison of Surgical Outcomes for Breast Cancer Related Lymphedema
    Ho OA, Lin CY, Cheng MH.
    Plast Reconstr Surg Glob Open. 2018
  34. A Prospective Evaluation of Lymphedema-Specific Quality-of-Life Outcomes Following Vascularized Lymph Node Transfer.
    Patel KM, Lin CY, Cheng MH.

    Ann Surg Oncol. 2015 Jul;22(7):2424-30. doi: 10.1245/s10434-014-4276-3. Epub 2014 Dec 17.
    https://www.ncbi.nlm.nih.gov/pubmed/25515196
  35. Proposed pathway and mechanism of vascularized lymph node flaps.
    Ito R, Zelken J, Yang CY, Lin CY, Cheng MH.

    Gynecol Oncol. 2016 Apr;141(1):182-8. doi: 10.1016/j.ygyno.2016.01.007. Epub 2016 Jan 7.
    https://www.ncbi.nlm.nih.gov/pubmed/26773469
  36. Outcomes of Lymphedema Microsurgery for Breast Cancer-related Lymphedema With or Without Microvascular Breast Reconstruction.
    Engel H, Lin CY, Huang JJ, Cheng MH.

    Ann Surg. 2017 Jun 7. doi: 10.1097/SLA.0000000000002322.
    https://www.ncbi.nlm.nih.gov/pubmed/28594742
  37. Validity of the Novel Taiwan Lymphoscintigraphy Staging and Correlation of Cheng LymphedemaGrading for Unilateral Extremity Lymphedema.
    Cheng MH, Pappalardo M, Lin C, Kuo CF, Lin CY, Chung KC.

    Ann Surg. 2018 Sep;268(3):513-525. doi: 10.1097/SLA.0000000000002917.
    https://www.ncbi.nlm.nih.gov/pubmed/30004927