Mihara Makoto, Zhou Han Peng, Hara Hisako, Tange Shuichi, Haragi Makiko
Department of Vascular Surgery, Saiseikai Kawaguchi General Hospital, Saitama, Japan.
Undergraduate of Medicine, The University of Tokyo, Tokyo, Japan.
Ann Vasc Surg. 2014 Oct;28(7):1798.e1-6. doi: 10.1016/j.avsg.2014.06.005. Epub 2014 Jun 12.
Two of the most common surgical lymph reconstructive interventions for the treatment of secondary lymphedema today are lymphaticovenous anastomosis (LVA) and lymph node transplant. However, neither of these approaches has proven enough evidence to be considered as an effective treatment measure. In this case report, we will introduce a "hybrid method" where combinations of these two conventional methods are used in treating a 52-year-old female patient who displays a mosaic pattern of aggravating secondary lymphedema. Preoperative indocyanine green lymphography assessment was used to identify the different stages of lymphedema within the symptomatic limbs. The application of the hybrid method has resulted in a faster improvement in limb circumference and tissue tenderness compared with when only LVA is performed and has resulted in successful recovery from lymphedema in our case. The hybrid method allows surgeons to select the most appropriate surgical approach for each region displaying a different severity staging of lymphedema, establishing a new order-made remedy for chronic secondary lymphedema patients.
目前，用于治疗继发性淋巴水肿的两种最常见的外科淋巴重建干预方法是淋巴管静脉吻合术（LVA）和淋巴结移植。然而，这些方法均未得到足够的证据证明可被视为有效的治疗措施。在本病例报告中，我们将介绍一种“混合方法”，即结合使用这两种传统方法来治疗一名52岁的女性患者，该患者表现出继发性淋巴水肿加重的镶嵌模式。术前使用吲哚菁绿淋巴造影评估来确定症状肢体淋巴水肿的不同阶段。与仅进行LVA相比，混合方法的应用使肢体周长和组织压痛得到更快改善，并且在我们的病例中实现了淋巴水肿的成功康复。混合方法使外科医生能够为显示不同严重程度分期的淋巴水肿的每个区域选择最合适的手术方法，为慢性继发性淋巴水肿患者建立了一种新的定制治疗方案。
