Lymphatic supermicrosurgery for the treatment of recurrent lymphocele and severe lymphorrhea
Lymphatic supermicrosurgery for the treatment of recurrent lymphocele and severe lymphorrhea
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DOI：
10.1002/micr.30435
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发表时间：
2019-05-01
期刊：
影响因子：
2.1
通讯作者：
Koshima, Isao
中科院分区：
文献类型：
--
作者：
Giacalone, Guido;Yamamoto, Takumi;Koshima, Isao
背景淋巴囊肿和淋巴漏是淋巴结切除术后常见的并发症。复发性淋巴囊肿和顽固性淋巴漏保守治疗尤其困难。我们描述了四例复发性淋巴囊肿和九例持续性淋巴漏患者的超显微手术治疗的结果。方法回顾性分析2013年至2017年收治的4例复发性淋巴囊肿患者的临床资料，其中腹股沟淋巴囊肿1例，大腿淋巴囊肿3例，复发性淋巴囊肿7 ~ 21 cm。9例腹股沟（n = 7）、阴囊（n = 1）或腋窝（n = 1）淋巴结或脂肪瘤切除后淋巴漏的患者转诊接受手术治疗。其中，5名患者出现引流系统，2名患者出现淋巴皮肤瘘。吲哚菁绿色（ICG）淋巴造影用于显示流向淋巴囊肿的淋巴管，以检测导致淋巴漏的破裂淋巴管，并用于术前淋巴映射。结果13例患者均成功治疗1例以上（平均3例，范围1-4例）下肢深静脉血栓，无围手术期并发症。所有四名患者的淋巴囊肿均得到解决，随访期间无复发记录。所有患者均通过在渗漏部位远端进行静脉吻合术治愈淋巴漏。随访期间未观察到复发。所有病例均在术中通过ICG淋巴造影证实了髂静脉吻合口的通畅性。结论淋巴管静脉吻合术是治疗复发性淋巴囊肿和持续性淋巴漏的一种微创、有效的方法。
Background Lymphocele and lymphorrhea are frequent complications after lymph node excision. Recurrent lymphoceles and intractable lymphorrhea are particularly difficult to treat conservatively. We describe the outcomes of four patients with recurrent lymphocele and nine patients with persistent lymphorrhea that were treated by supermicrosurgery. Methods Four patients with recurrent lymphoceles with a size between 7 and 21 cm and located in the groin (n = 1) or upper leg (n = 3), were referred for surgical treatment between 2013 and 2017 after unsuccessful conservative therapy. Nine patients with lymphorrhea from the groin (n = 7), scrotum (n = 1), or axilla (n = 1) after lymph node or lipoma excision were referred for surgical treatment. Of these, five patients presented with a drainage system and two had a lymphocutaneous fistula. Indocyanine green (ICG) lymphography was used to visualize the lymphatic flow toward the lymphocele, to detect ruptured lymph vessels causing lymphorrhea and for preoperative lymphatic mapping. Results All 13 patients were successfully treated by one or more (mean: 3, range 1-4) lymphaticovenous anastomoses without perioperative complications. The lymphoceles resolved in all four patients, and no recurrence was recorded during follow-up. The lymphorrhea was cured in all patients by means of lymphaticovenous anastomosis performed distal to the site of leakage. No recurrence was observed during follow-up. The patency of the lymphaticovenous anastomosis was confirmed intraoperatively by means of ICG lymphography in all cases. Conclusion Lymphaticovenous anastomosis is a minimally invasive and effective procedure for the treatment of recurrent lymphocele and persistent lymphorrhea.