Minimally Invasive Lymphatic Supermicrosurgery (MILS) Indocyanine Green Lymphography-Guided Simultaneous Multisite Lymphaticovenular Anastomoses via Millimeter Skin Incisions
Minimally Invasive Lymphatic Supermicrosurgery (MILS) Indocyanine Green Lymphography-Guided Simultaneous Multisite Lymphaticovenular Anastomoses via Millimeter Skin Incisions
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DOI：
10.1097/sap.0b013e3182605580
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发表时间：
2014-01-01
影响因子：
1.5
通讯作者：
Koshima, Isao
中科院分区：
文献类型：
--
作者：
Yamamoto, Takumi;Narushima, Mitsunaga;Koshima, Isao
在各种外科治疗中，淋巴管吻合术(LVA)将充血的淋巴绕过静脉循环，是侵袭性最小的外科治疗方法。然而，它通常需要皮肤切开约3厘米，手术时间约为4小时。在吲哚青绿淋巴造影术的指导下，多名超微外科医生可以在局部麻醉下，通过长度小于1 cm的小皮肤切口，在大约2小时内同时进行LVAS，从而实现微创淋巴超微手术(MILS)。我们对11例压迫难治性外周淋巴水肿行MILS治疗。LVA皮肤切开长度为1~9 mm。平均手术时间1.82小时。11条肢体中，10条肢体术后体积缩小。吲哚青绿淋巴造影可以清晰地显示浅表淋巴流动，帮助我们在LVA手术中确定准确的皮肤切开部位和寻找淋巴管，缩短皮肤切开长度和手术时间。微创淋巴超显微手术可作为治疗压迫顽固性外周淋巴水肿的最合理方法。
Among various surgical treatments, lymphaticovenular anastomosis (LVA), which bypasses congested lymph into venous circulation, is the least invasive surgical treatment. However, it usually entails skin incisions of around 3 cm, and operation time of around 4 hours. With multiple supermicrosurgeons under guidance of indocyanine green lymphography, LVAs can be simultaneously performed under local anesthesia within approximately 2 hours via small skin incisions with length less than 1 cm, allowing minimally invasive lymphatic supermicrosurgery (MILS). We performed MILS on 11 limbs of compression-refractory peripheral lymphedema cases. Length of skin incision for LVA ranged from 1 to 9 mm. Average operation time was 1.82 hours. Of the11 limbs, 10 showed postoperative volume reduction. Indocyanine green lymphography clearly visualizes superficial lymph flows, which helps us to decide precise skin incision sites and find lymphatic vessels in LVA surgery, shortening skin incision length and operation time. Minimally invasive lymphatic supermicrosurgery can serve as the most reasonable treatment of compressionrefractory peripheral lymphedema.