The Recipient Venule in Supermicrosurgical Lymphaticovenular Anastomosis: Flow Dynamic Classification and Correlation with Surgical Outcomes
The Recipient Venule in Supermicrosurgical Lymphaticovenular Anastomosis: Flow Dynamic Classification and Correlation with Surgical Outcomes
复制标题
超显微外科淋巴小静脉吻合术中的受体小静脉：血流动力学分类及其与手术结果的相关性
DOI：
10.1055/s-0038-1649518
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发表时间：
2018
影响因子：
2.1
通讯作者：
A. Hayashi
中科院分区：
文献类型：
--
作者：
G. Visconti;M. Salgarello;A. Hayashi
摘要背景 有关淋巴小静脉吻合术（LVA）的文献中通常忽略小静脉。本研究的目的是分析 LVA 中受主小静脉的血流动力学及其对手术结果的影响。患者和方法 收集了2014年8月至2016年5月期间在两家机构接受LVA治疗的128例四肢淋巴水肿患者的数据。根据受主小静脉的血流动态将其分为回流、松弛和出口（BSO分类）。评估定量（下肢淋巴水肿/上肢淋巴水肿指数）和定性结果（压缩衣的需要和压缩衣类别）。卡方检验或 Fisher 精确检验用于分类变量，独立样本 t 检验用于连续变量。通过 Mantel-Haenszel 检验分析淋巴管变性状态（正常、扩张、收缩、硬化型 [NECST]）和 BSO 分类与结果之间的关联。结果 总共128名患者中，37名患有上肢淋巴水肿，91名患有下肢淋巴水肿。每个患者平均进行四次 LVA（范围：2-8）。观察到 NECST 和 BSO 类别之间存在显着关联，并对结果进行了评估。与正常至扩张的收集器患者相比，收缩性和硬化收集器患者的综合结果较差的几率是正常至扩张收集器患者的 2.24 倍 (p<0.05)。与没有出口或松弛模式的患者相比，有回流小静脉的患者复合结果较差的几率是 3.32 倍 (p<0.05)。结论 无论淋巴管变性状态如何，受体小静脉血流动力学亚型对接受 LVA 治疗淋巴水肿的患者的手术结果具有显着影响。在术前标测中找到有利的小静脉可能会提高手术效果。
Abstract Background Venules have been usually neglected in the literature on lymphaticovenular anastomosis (LVA). The aim of this study was to analyze the flow dynamic of recipient venules in LVA and their impact on the surgical outcomes. Patients and Methods Data from 128 patients affected by extremity lymphedema, who underwent LVA, were collected in two institutions from August 2014 to May 2016. Recipient venules were classified according to their flow dynamic into backflow, slack, and outlet (BSO classification). Quantitative (lower extremity lymphedema/upper extremity lymphedema index) and qualitative outcomes (needing of compression garment and compression garment class) were evaluated. Chi-square test or Fisher's exact test was used for categorical variables and independent-samples t-test for continuous variables. The association between lymphatic collector degeneration status (normal, ectasis, contractile, sclerotic type [NECST]) and BSO classification with the outcomes was analyzed by the Mantel–Haenszel test. Results On a total of 128 patients, 37 suffered from upper and 91 from lower limb lymphedema. An average number of four LVA were performed for each patient (range: 2–8). A significant association was observed between NECST and BSO categories and the outcomes were evaluated. Patients with contractile and sclerotic collectors had 2.24 times the odd of having poor composite outcome compared with those with normal-to-ectasis collectors (p < 0.05). Patients with backflow venules had 3.32 times the odd of having poor composite outcome compared with those without outlet or slack pattern (p < 0.05). Conclusion The subtype of recipient venule flow dynamic has a significant impact on the surgical outcome of patients undergoing LVA for the treatment of lymphedema, regardless of the lymphatic collector degeneration status. Locating favorable venules in the preoperative mapping might enhance the surgical outcomes.