Lymphaticovenular anastomosis for lymph vessel injury in the pelvis and groin
Lymphaticovenular anastomosis for lymph vessel injury in the pelvis and groin
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DOI：
10.1002/micr.30741
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发表时间：
2021-04-03
期刊：
影响因子：
2.1
通讯作者：
Yoshida, Sei
中科院分区：
文献类型：
--
作者：
Kadota, Hideki;Shimamoto, Ryo;Yoshida, Sei
背景：当常规治疗失败时，骨盆和腹股沟淋巴管损伤引起的淋巴疾病需要立即进行临床治疗。我们的目的是明确淋巴小静脉吻合术（LVA）治疗这些淋巴疾病的有效性和适应症。方法回顾性分析6例因骨盆和腹股沟淋巴管损伤而行LVA的患者。具体病理包括腹股沟淋巴漏（N = 3）、乳糜腹水（N = 2）、腹膜后淋巴囊肿（N = 1）。最大淋巴液漏量150 ~ 2600 mL / d。常规治疗（压迫、引流、禁食、给药生长抑素、负压伤口治疗或淋巴管结扎）未能控制所有病例的渗漏。在使用淋巴显像确定了淋巴管损伤部位后，我们进行了下肢LVAs。我们优先将lva放置在经吲哚菁绿淋巴显像显示线性模式的大腿部位。术后评估淋巴液漏气量减少情况，引流量接近0 ml时记录漏液停止。结果平均在大腿4.3个部位（范围3-6个部位）和小腿2.7个部位（范围0-6个部位）进行LVA。所有病例术后平均6天（范围1-11天）淋巴液渗漏停止。在平均随访2.9年（0.5-5.5年）期间未观察到症状复发。结论LVA疗效好，见效快。我们推荐下肢LVA治疗由于骨盆和腹股沟淋巴管损伤引起的淋巴疾病。
Background Lymphatic diseases due to lymph vessel injuries in the pelvis and groin require immediate clinical attention when conventional treatments fail. We aimed to clarify the effectiveness of and indications for lymphaticovenular anastomosis (LVA) to treat these lymphatic diseases.Methods We retrospectively evaluated six patients who underwent LVA for lymphatic diseases due to lymph vessel injuries in the pelvis and groin. Specific pathologies included groin lymphorrhea (N = 3), chylous ascites (N = 2), and retroperitoneal lymphocele (N = 1). The maximum lymphatic fluid leakage volume was 150-2600 mL daily. Conventional treatments (compression, drainage, fasting, somatostatin administration, negative pressure wound therapy, or lymph vessel ligation) had failed to control leakage in all cases. We performed lower extremity LVAs after confirming the site of lymph vessel injury using lymphoscintigraphy. We preferentially placed LVAs in thigh sites that showed a linear pattern by indocyanine green lymphography. Postoperative lymphatic fluid leakage volume reduction was evaluated, and leakage cessation was recorded when the drainage volume approached 0 mL.Results LVA was performed at an average of 4.3 sites (range, 3-6 sites) in the thigh and 2.7 sites (range, 0-6 sites) in the lower leg. Lymphatic fluid leakage ceased in all cases after a mean of 6 days (range, 1-11 days) postoperatively. No recurrence of symptoms was observed during an average follow-up of 2.9 (range, 0.5-5.5) years.Conclusions LVA demonstrates excellent and rapid effects. We recommend lower extremity LVA for the treatment of lymphatic diseases due to lymph vessel injuries in the pelvis and groin.