淋巴管静脉吻合治疗肢体获得性淋巴水肿临床效果

  目的  探讨应用淋巴管静脉吻合治疗肢体获得性淋巴水肿的初步治疗效果。  方法  2013年9月至2014年8月在北京协和医院整形外科应用淋巴管静脉吻合进行治疗的肢体获得性淋巴水肿患者15例, 其中单侧肢体淋巴水肿12例, 双侧肢体淋巴水肿3例。术前应用吲哚菁绿荧光显像明确淋巴水肿分期及淋巴管通畅度。应用显微外科技术, 根据患肢水肿位置确定每例患者拟吻合的平面及吻合数目。术前术后在相同位置进行患侧肢体周径测量, 计算周径减少度。  结果  15例患者淋巴管静脉吻合手术均顺利完成。术后随访6~10个月(平均8.3个月), 上肢肢体周径减少度33.7%, 下肢周径减少度20.0%, 所有患者术后均再无淋巴管炎发生。  结论  淋巴管静脉吻合可用于治疗早期可凹性淋巴水肿, 术前经淋巴管荧光造影明确淋巴管通畅、无纤维化的淋巴水肿可以获得良好的治疗效果。

Clinical Effectiveness of Lymphaticovenular Anastomosis for Secondary Extremity Lymphedema

  Objective  To investigate the clinical effectiveness of lymphaticovenular anastomosis in secondary extremity lymphedema.  Methods  Fifteen patients with secondary extremity lymphedema treated with lymphaticovenular anastomosis between September 2013 and August 2014 at Peking Union Medical College Hospital were included in this study, of whom 12 were unilateral, and 3 were bilateral. Indocyanine green lymphography was used before the operation to evaluate the severity of lymphedema and the patency of lymphatic vessels. Microsurgery was applied to determine the site and number of anastomosis. The circumference of the involved limb was measured before and after the operation at the same level to calculate the reduction of circumference.  Results  Lymphaticovenular anastomosis was successfully conducted in all the 15 patients. The follow-up period ranged from 6 to 10 months (mean 8.3 months), and the average circumference reductions in upper and lower limbs were 33.7% and 20.0%, respectively. None of the patients suffered recurrent lymphangitis after the operation.  Conclusion  Lymphaticovenular anastomosis is an effective treatment for early pitting extremity lymphedema, especially for the cases with patent lymphatic vessels without fibrosis as confirmed by preoperative lymphography.