Van den Brande Pierre, von Kemp Karl, Aerden Dimitri, Debing Erik, Vanhulle Alain, Staelens Ivan, Haentjens Patrick
Department of Vascular Surgery, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
Ann Vasc Surg. 2012 Aug;26(6):833-8. doi: 10.1016/j.avsg.2012.02.009. Epub 2012 Jun 21.
Lymphocutaneous fistulas occurring after vascular procedures of the lower limb are a rare, but frustrating, complication. Many treatment options exist, but may lead to inconsistent results, with infection, delayed wound healing, and prolonged hospital stay. We present a simple surgical treatment of wound closure and drainage.
In this single-center, single-intervention, observational clinical study (case series), prospectively collected data of 23 consecutive lymphocutaneous fistulas in 22 patients (19 male and three female; age, 42 to 91 years) treated between June 2005 and October 2008 were retrospectively analyzed. Twenty-two fistulas were situated in the groin and one at the knee incision. The standardized therapy consisted of the installation of a Redon to drain the lymph, and accurate closure of the wound. Postoperatively, drainage was maintained for 21 days: suction Redon drainage for the first 7 days, passive Redon drainage for the next 7 days, and further drainage in a pouch after removal of the drain for the last 7 days.
In 19 of the initial 23 lymphocutaneous fistulas, the whole drainage procedure was completed, with healing of the wound, without infection, recurrence, or lymphocele formation after 1 year of follow-up. In these cases, there had been a steady decrease of daily lymph drainage: a mean of 163.4 (standard error on the mean, 39.6) mL on the first day of suction, 56.8 (15.5) mL on the first day of passive drainage, 11.6 (4.3) mL on the last day of passive drainage, and 2.1 (0.9) mL on the 21st day when the drainage treatment was stopped. In four fistulas, this treatment was considered a failure because of inadvertent early drain removal (two cases), infection (one case), and lymphorrhea recurrence with wound breakdown (one case).
This standardized surgical therapy, consisting of accurate wound closure and 3 weeks of drainage, allowed the healing of 19 of 23 postoperative lymphocutaneous fistulas (an 82.6 % success rate), without infection, recurrence, or lymphocele formation after 1 year of follow up.
下肢血管手术后发生的淋巴皮肤瘘是一种罕见但令人沮丧的并发症。有多种治疗选择，但可能导致结果不一致，出现感染、伤口愈合延迟和住院时间延长等情况。我们介绍一种简单的伤口闭合和引流手术治疗方法。
在这项单中心、单一干预、观察性临床研究（病例系列）中，对2005年6月至2008年10月期间治疗的22例患者（19例男性和3例女性；年龄42至91岁）中连续23例淋巴皮肤瘘的前瞻性收集数据进行回顾性分析。22例瘘位于腹股沟，1例位于膝部切口处。标准化治疗包括放置一根雷顿引流管引流淋巴液，并精确闭合伤口。术后引流维持21天：前7天采用负压雷顿引流，接下来7天采用被动雷顿引流，拔除引流管后最后7天在袋中进一步引流。
最初的23例淋巴皮肤瘘中有19例完成了整个引流过程，伤口愈合，随访1年后无感染、复发或淋巴囊肿形成。在这些病例中，每日淋巴引流量稳步下降：负压引流第一天平均为163.4（平均标准误，39.6）毫升，被动引流第一天为56.8（15.5）毫升，被动引流最后一天为11.6（4.3）毫升，引流治疗停止时第21天为2.1（0.9）毫升。4例瘘管治疗被认为失败，原因分别是引流管意外过早拔除（2例）、感染（1例）以及伤口裂开伴淋巴漏复发（1例）。
这种由精确伤口闭合和3周引流组成的标准化手术治疗，使23例术后淋巴皮肤瘘中的19例愈合（成功率为82.6%），随访1年后无感染、复发或淋巴囊肿形成。
