Department of Plastic and Reconstructive Surgery, Nimes University Hospital, pl Pr Robert Debré, 30000 Nimes, France.
J Plast Reconstr Aesthet Surg. 2013 Feb;66(2):201-6. doi: 10.1016/j.bjps.2012.08.049. Epub 2012 Oct 4.
Head and neck lymphoedema secondary to jugular lymphadenectomy is a severe issue, without efficient solution. Successful treatment of lymphoedema of the upper and lower limbs has become possible with supermicrosurgical lymphaticovenular anastomosis. The technique based on two end-to-side anastomosis is named π-shaped lymphaticovenular anastomosis. We have evaluated this method for chronic head and neck lymphoedema.
From November 2010 to April 2011, four patients with a chronic head and neck lymphoedema were treated by π-shaped lymphaticovenular anastomosis. Three patients had a unilateral lymphoedema, and one patient had a bilateral lymphoedema. The mean age of the patients was 63.2 years (range, 46-77 years). The mean duration of the lymphoedema was 2.6 years (range, 1-5). Every patient was operated under local anaesthesia through a face-lift skin incision. One π-shaped lymphaticovenular anastomosis was performed at each operative site.
The average operative time to perform one π-shaped lymphaticovenular anastomosis was 1.9 h (range, 1.8-2.5). The calibre of lymphatic vessels used for lymphaticovenular anastomosis ranged from 0.3 to 0.7 mm (average, 0.5). A venous back-flow was found in seven lymphaticovenular anastomosis (70%). Three patients (75%) had a qualitative improvement of skin tissue and a significant circumferential reduction after surgery. The average circumferential differential reduction rate was 3.7% (range, 0.6-7.8) (p=0.006). The average cross-sectional area differential reduction rate was 7.2% (range, 1.2-15.1) (p=0.007). The average volume differential reduction rate was 6.9% (range, 2-14.8) (p=0.05).
The authors present a new option to treat head and neck lymphoedema. π-Shaped lymphaticovenular anastomosis is an effective method to reduce the severity of skin tissue fibrosis and lymphoedema volume. Further studies with larger groups of patients are required to confirm the outcome of this preliminary study. EBM Level=level 4.
颈淋巴结清扫术后继发的头颈部淋巴水肿是一个严重的问题，目前尚无有效的解决方法。超显微淋巴管静脉吻合术已成功应用于上下肢淋巴水肿的治疗。这种基于端端吻合的技术被命名为“π 形淋巴管静脉吻合术”。我们已经评估了这种方法治疗慢性头颈部淋巴水肿的效果。
从 2010 年 11 月至 2011 年 4 月，4 例慢性头颈部淋巴水肿患者接受了“π 形淋巴管静脉吻合术”治疗。3 例为单侧淋巴水肿，1 例为双侧淋巴水肿。患者的平均年龄为 63.2 岁（范围，46-77 岁）。淋巴水肿的平均病程为 2.6 年（范围，1-5 年）。所有患者均在局部麻醉下通过面部提升皮瓣切口进行手术。每个手术部位进行 1 次“π 形淋巴管静脉吻合术”。
完成 1 次“π 形淋巴管静脉吻合术”的平均手术时间为 1.9 小时（范围，1.8-2.5 小时）。用于淋巴管静脉吻合的淋巴管直径为 0.3-0.7 毫米（平均，0.5 毫米）。7 个淋巴管静脉吻合口（70%）发现静脉回流。3 例（75%）患者术后皮肤组织质地改善，周长显著缩小。平均周长差异缩小率为 3.7%（范围，0.6-7.8）（p=0.006）。平均横截面积差异缩小率为 7.2%（范围，1.2-15.1）（p=0.007）。平均体积差异缩小率为 6.9%（范围，2-14.8）（p=0.05）。
作者提出了一种治疗头颈部淋巴水肿的新方法。“π 形淋巴管静脉吻合术”是一种有效减轻皮肤组织纤维化和淋巴水肿体积严重程度的方法。需要进一步的研究来证实这一初步研究的结果，该研究的证据水平为 4 级。
