Histologic Evaluation of Lymphaticovenular Anastomosis Outcomes in the Rat Experimental Model: Comparison of Cases with Patency and Obstruction.
Histologic Evaluation of Lymphaticovenular Anastomosis Outcomes in the Rat Experimental Model: Comparison of Cases with Patency and Obstruction.
复制标题
大鼠实验模型中淋巴管静脉吻合结果的组织学评估：通畅和阻塞病例的比较。
DOI：
10.1097/prs.0000000000001884
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发表时间：
2016
期刊：
影响因子：
--
通讯作者：
Sugiyama N.
中科院分区：
文献类型：
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作者：
Onoda S;Kimata Y;Matsumoto K;Yamada K;Tokuyama E;Sugiyama N.
背景：淋巴小囊吻合在淋巴水肿的外科治疗中起着重要的作用。淋巴-小静脉吻合术的结果是根据水肿的变化来评估的；然而，单独评估吻合本身是困难的。作者利用动物实验模型对淋巴-小静脉吻合术的组织学变化进行了详细的检查，并确定了成功的重要因素。方法：采用Wistar大鼠腰淋巴管和髂腰静脉建立实验性淋巴-小静脉吻合模型。作者在显微镜下进行吻合，并在光学和电子显微镜下观察术后组织学变化。此外，对吻合区附近有通畅和梗阻的病例，采用电镜和组织学详细检查。结果：淋巴小囊吻合术后即刻、术后1周、术后1月通畅率分别为100%（20 / 20）、70%（14 / 20）、65%。电镜详细检查吻合区显示，在通畅的情况下，内皮细胞没有明显的转化，形成了光滑的层。梗阻时，内皮细胞相应区域结构不规则。结论：淋巴小囊吻合后血管梗阻可能与内皮层排列不规则有关，导致内皮下组织暴露，血小板形成。本研究对吻合后部分改变及梗阻的原因进行了阐述。作者的结果可能会使淋巴小囊吻合的改进转化回实际的临床手术。
Background:Lymphaticovenular anastomosis plays an important role in the surgical treatment of lymphedema. The outcomes of lymphaticovenular anastomosis are evaluated based on changes in edema; however, isolated assessment of the anastomosis itself is difficult. The authors used an animal experimental model to conduct a detailed examination of histologic changes associated with lymphaticovenular anastomosis and determined the factors important for success.Methods:The experimental lymphaticovenular anastomosis model was created using lumbar lymph ducts and iliolumbar veins of Wistar rats. The authors performed anastomosis under a microscope and reviewed postoperative histologic changes using optical and electron microscopy. In addition, electron microscopy and histology were used for detailed examination of the area in the vicinity of the anastomotic region in cases with patency and obstruction.Results:The patency rates immediately after, 1 week after, and 1 month after lymphaticovenular anastomosis were 100 percent (20 of 20), 70 percent (14 of 20), and 65 percent, respectively. A detailed examination of the anastomotic region with electron microscopy revealed that, in cases with patency, there was no notable transformation of the endothelial cells, which formed a smooth layer. In contrast, in obstruction cases, the corresponding region of the endothelium was irregular in structure.Conclusions:Vessel obstruction after lymphaticovenular anastomosis may be associated with irregular arrangement of the endothelial layer, leading to exposure of subendothelial tissues and platelet formation. One part of the postoperative changes after anastomosis and a cause of obstruction were elucidated in this study. The authors’ results may enable improvements in lymphaticovenular anastomosis by translating back to real clinical operations.