Comparison of Primary and Secondary Lower-Extremity Lymphedema Treated with Supermicrosurgical Lymphaticovenous Anastomosis and Lymphaticovenous Implantation
Comparison of Primary and Secondary Lower-Extremity Lymphedema Treated with Supermicrosurgical Lymphaticovenous Anastomosis and Lymphaticovenous Implantation
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DOI：
10.1055/s-0029-1243299
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发表时间：
2010-02-01
影响因子：
2.1
通讯作者：
Topalan, Murat
中科院分区：
文献类型：
--
作者：
Demirtas, Yener;Ozturk, Nuray;Topalan, Murat
尽管一些作者先前指出微淋巴管手术不适用于原发性水肿，但基于大多数患者的淋巴管发育不全和微淋巴管手术产生显著改善的观察结果，报告了相反的观点。本研究的目的是比较原发性和继发性下肢水肿病例采用股静脉分流术治疗的术中发现和结局。在2006年12月至2009年4月期间，对80例原发性下肢水肿和21例继发性下肢水肿进行了显微淋巴管手术。根据淋巴管的形态学和精确淋巴结转移的可能性、对治疗的反应以及随访期间基于体积测量的最终结果，对这两组肢体进行比较。继发性肢体水肿的吻合器形态较一致，20/21肢至少有一个大于0.3mm的收集器可供吻合。原发性肢体水肿组80条肢体中，有13条肢体的毛细血管直径小于0.3mm。因此，84%的原发性肢体水肿和95%的继发性肢体水肿可以进行超显微外科股静脉吻合。继发性水肿组的水肿减轻较早，但两组间水肿体积的平均减少相当。微淋巴管手术，虽然更有效，并提供作为治疗继发性水肿的选择，也将是一个有价值的和相关的治疗原发性水肿。
Although some authors previously stated that microlymphatic surgery does not have application to primary lymphedema, opposite views are reported based on the observations that the lymphatics were not hypoplastic in majority of these patients and microlymphatic surgery yielded significant improvement. The aim of this study was to compare the intraoperative findings and outcomes of primary and secondary lower-extremity lymphedema cases treated with lymphaticovenous shunts. Between December 2006 and April 2009, microlymphatic surgery was performed in 80 lower extremities with primary and 21 with secondary lymphedema. These two groups of extremities are compared according to the morphology of the lymphatic vessels and possibility of precise anastomoses, their response to the treatment, and final outcomes based on volumetric measurements during the follow-up period. The morphology of the lymphatics in secondary lymphedema was more consistent, and at least one collector larger than 0.3 mm was available for anastomosis in 20 of 21 extremities. In the primary lymphedema group, the lymphatics were smaller than 0.3 mm in 13 of 80 extremities. It was, therefore, possible to perform supermicrosurgical lymphaticovenous anastomosis in 84% of extremities with primary lymphedema and 95% of extremities with secondary lymphedema. Reduction of the edema occurred earlier in the secondary lymphedema group, but the mean reduction in the edema volume was comparable between the two groups. Microlymphatic surgery, although more effective and offered as the treatment of choice for secondary lymphedema, would also be a valuable and relevant treatment of primary lymphedema.