Campisi C
Department of General and Emergency Surgery, Martino-University of Genoa, Italy.
Lymphology. 1991 Jun;24(2):71-6.
We report preliminary experimental studies in rats and rabbits together with clinical observations in 39 patients with chronic lymphedema undergoing interposition autologous lymphatic-venous-lymphatic (LVL) anastomoses. This microsurgical operative technique is an alternative to other lymphatic shunting methods particularly where venous disease coexists in the same limb and where direct lymphatic-venous bypass is accordingly inappropriate. Preoperative diagnostic evaluation including lymphatic and venous isotopic scintigraphy, Doppler venous flow metrics and pressure manometry play an essential role in delineating the status of both the lymphatic and venous systems and in determining which microsurgical procedure, if any, is indicated. Our microsurgical method consists of inserting suitably large and lengthy autologous venous grafts between lymphatic collectors above and below the site of blockage to lymph flow. The data demonstrate the feasibility of the LVL technique experimentally and in 39 patients with obstructive lymphedema (either arm or leg). Using LVL shunt, improvement was seen in both limb function and edema, and in some, edema regression was permanent for as long as 5 years.
我们报告了在大鼠和兔子身上进行的初步实验研究，以及对39例接受自体淋巴管 - 静脉 - 淋巴管（LVL）吻合术治疗慢性淋巴水肿患者的临床观察。这种显微外科手术技术是其他淋巴分流方法的替代方案，特别是在同一肢体同时存在静脉疾病且直接淋巴管 - 静脉旁路因此不合适的情况下。术前诊断评估，包括淋巴管和静脉同位素闪烁扫描、多普勒静脉血流指标和压力测量，在描绘淋巴和静脉系统的状况以及确定是否需要进行显微外科手术（如有）方面起着至关重要的作用。我们的显微外科方法包括在淋巴流阻塞部位上方和下方的淋巴管收集器之间插入适当大且长的自体静脉移植物。数据证明了LVL技术在实验上以及在39例阻塞性淋巴水肿（手臂或腿部）患者中的可行性。使用LVL分流术，肢体功能和水肿均有改善，在一些患者中，水肿消退持续长达5年。
