Tokyo, Japan From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo.
Plast Reconstr Surg. 2011 May;127(5):1987-1992. doi: 10.1097/PRS.0b013e31820cf5c6.
Lymphaticovenular anastomosis has become an increasingly common treatment for lymphedema. Supermicrosurgical techniques are essential for the successful performance of lymphaticovenular anastomosis. A positive correlation between the number of lymphaticovenular anastomoses performed and therapeutic efficacy has been reported, and in performing these anastomoses, the establishment of as many bypasses as possible is important.
Forty limbs of 20 patients with lower extremity lymphedema who underwent lymphaticovenular anastomosis in our department were assessed. All cases were performed under local anesthesia using two to four surgical microscopes. A new method of anastomosis, lambda-shaped anastomosis assisted by intravascular stenting, was chosen in required cases.
Lymphaticovenular anastomoses resulted in 186 anastomoses on 20 patients with lower extremity lymphedema; the average number of anastomoses per case was 9.3 (range, five to 18). The number of surgical microscopes used ranged from two to four (average, 3.3), and the duration of the operation ranged from 3 to 5 hours (average, 4.1). In the cases of lambda-shaped anastomosis (n = 11), the number of anastomoses was significantly greater than in the cases without lambda-shaped anastomosis (n = 9; 10.2 ± 2.3 versus 8.2 ± 1.4; p < 0.05).
Lambda-shaped anastomosis assisted by intravascular stenting is a safe and relatively easy method that can be performed by surgeons with less than 1 year of experience in microsurgery. This in turn allows efficient lymphaticovenular anastomoses to be performed simultaneously by a team of surgeons, resulting in an increased number of bypasses.
淋巴管静脉吻合术已成为治疗淋巴水肿的一种越来越常见的方法。超显微外科技术对于成功进行淋巴管静脉吻合术至关重要。已经报道了进行的淋巴管静脉吻合术数量与治疗效果之间存在正相关关系，并且在进行这些吻合术时，建立尽可能多的旁路非常重要。
评估了 20 例下肢淋巴水肿患者的 40 条肢体，这些患者在我科接受了淋巴管静脉吻合术。所有病例均在局部麻醉下使用 2 到 4 台手术显微镜进行。在需要的情况下，选择了一种新的吻合方法，即血管内支架辅助的 lambda 形吻合术。
淋巴管静脉吻合术导致 20 例下肢淋巴水肿患者共进行了 186 次吻合术；每个病例的平均吻合术数量为 9.3（范围为 5 到 18）。使用的手术显微镜数量从 2 到 4 台不等（平均为 3.3），手术时间从 3 到 5 小时不等（平均为 4.1）。在 lambda 形吻合术（n = 11）的情况下，吻合术的数量明显多于没有 lambda 形吻合术的情况（n = 9；10.2 ± 2.3 比 8.2 ± 1.4；p < 0.05）。
血管内支架辅助的 lambda 形吻合术是一种安全且相对简单的方法，经验不足 1 年的显微外科医生也可以进行。这反过来又可以使一组外科医生同时进行高效的淋巴管静脉吻合术，从而增加旁路数量。
