Shaper N J, Rutt D R, Browse N L
Division of Surgery, United Medical School, Guy's Hospital, London, UK.
Br J Surg. 1992 Jul;79(7):633-6. doi: 10.1002/bjs.1800790711.
The treatment of lymphoedema is difficult; conservative and surgical management show variable results. Lymphovenous anastomoses (LVAs) in experimental animals and patients give poor results in the treatment of primary lymphoedema and variable results in that of secondary lymphoedema. Conventional sutured LVAs were compared with anastomoses using polytetrafluoroethylene (Teflon) stents; 32 sutured and 21 stented LVAs were constructed in 16 rabbits with normal lymphatics. Anastomoses were assessed for quality and patency at 1-16 weeks by direct exposure; 27 cases were further assessed using lymphangiography. Patency in stented and sutured LVAs was 71 and 38 per cent at 1 week, and 38 and 8 per cent at 3 weeks, respectively. After 4 weeks all anastomoses were occluded. The quality of stented LVAs seemed to be higher than that of sutured LVAs. Stented LVAs are feasible and probably superior to conventional sutured LVAs. However, the patency of LVAs is of short duration because of the disadvantageous pressure gradient from lymphatics to veins, and this limits their clinical application.
淋巴水肿的治疗颇具难度；保守治疗及手术治疗的效果各异。在实验动物和患者身上进行的淋巴管静脉吻合术（LVA），对原发性淋巴水肿的治疗效果欠佳，对继发性淋巴水肿的治疗效果则参差不齐。对传统缝合式淋巴管静脉吻合术与使用聚四氟乙烯（特氟龙）支架的吻合术进行了比较；在16只淋巴管正常的兔子身上构建了32例缝合式LVA和21例带支架的LVA。通过直接暴露在1至16周时对吻合口的质量及通畅情况进行评估；27例病例进一步采用淋巴管造影进行评估。带支架的LVA和缝合式LVA在1周时的通畅率分别为71%和38%，在3周时分别为38%和8%。4周后所有吻合口均闭塞。带支架的LVA的质量似乎高于缝合式LVA。带支架的LVA是可行的，且可能优于传统缝合式LVA。然而，由于从淋巴管到静脉存在不利的压力梯度，LVA的通畅时间较短，这限制了它们的临床应用。
