Changing the Paradigm: Lymphovenous Anastomosis in Advanced Stage Lower Extremity Lymphedema
Changing the Paradigm: Lymphovenous Anastomosis in Advanced Stage Lower Extremity Lymphedema
复制标题
DOI：
10.1097/prs.0000000000007507
复制
发表时间：
2021-01-01
影响因子：
3.6
通讯作者：
Hong, Joon Pio
中科院分区：
文献类型：
--
作者：
Cha, Han Gyu;Oh, Tea Min;Hong, Joon Pio
背景资料：传统上，淋巴静脉吻合术并不是晚期水肿患者的常规手术，因为很难识别功能性淋巴管。方法：回顾性分析42例（50条下肢）晚期下肢功能性淋巴静脉闭塞症（晚期2~3期）患者的临床资料，采用双功能超声和磁共振淋巴管造影检查，观察功能性淋巴管闭塞症的发生情况，并对淋巴静脉吻合术治疗晚期下肢功能性淋巴管闭塞症的临床效果进行评价。结果：利用位于浅筋膜下深层脂肪内的淋巴管，平均每肢行4.64个淋巴静脉吻合术。淋巴管直径0.35~1mm，平均0.61mm。术后平均肢体体积减少14.0%，3个月后减少15.2%，6个月和1年后减少15.5%（p <0.001）。对于单侧肢体水肿患者，32.4%的患者与对侧术后相比，手术后体积超过10%，而20.5%的患者体积超过20%。术后蜂窝织炎的发生率从0.84/年下降到0.07/年（p <0.001）。结论：术前超声和磁共振淋巴管造影可明确功能性淋巴管，淋巴静脉曲张能有效缩小晚期下肢水肿患者的肢体体积，改善患者的主观症状。
Background: Traditionally, lymphovenous anastomosis is not routinely performed in patients with advanced stage lymphedema because of difficulty with identifying functioning lymphatics. This study pniscins the use of duplex ultrasound and magnetic resonance lymphangiography to identify functional lymphatics and reports the clinical outcome of lymphovenous anastomosis in advanced stage lower extremity lymphedema patients.Methods: This was a retrospective study of 42 patients (50 lower limbs) with advanced lymphedema (late stage 2 or 3) that underwent functional lymphovenous anastomoses. Functional lymphatic vessels were identified preoperatively using magnetic resonance lymphangiography and duplex ultrasound.Results: An average of 4.64 lymphovenous anastomoses were performed per limb using the lymphatics located in the deep fat underneath the superficial fascia. The average diameter of lymphatic vessels was 0.61 mm (range, 0.35 to 1 mm). The average limb volume was reduced 14.0 percent post-operatively, followed by 15.2 percent after 3 months, and 15.5 percent after 6 months and 1 year (p < 0.001). For patients with unilateral lymphedema, 32.4 percent had less than 10 percent volume excess compared to the contralateral side post, operatively, whereas 20.5 percent had more than 20 percent volume excess. The incidence of cellulitis decreased from 0.84 per year to 0.07 per year after surgery (p< 0.001).Conclusion: This study shows that functioning lymphatic vessels can be identified preoperatively using ultrasound and magnetic resonance lymphangiography; thus, lymphovenous anastomoses can effectively reduce the volume of the limb and improve subjective symptoms in patients with advanced stage lymphedema of the lower extremity.