Ishiura Ryohei, Yamamoto Takumi, Saito Takahumi, Mito Daisuke, Iida Takuya
Tokyo, Japan.
From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo; the Department of Plastic Surgery, Cancer Institute Ariake Hospital; and the Department of Plastic Surgery, Tokyo Metropolitan Bokutoh Hospital.
Plast Reconstr Surg. 2017 Jun;139(6):1407-1413. doi: 10.1097/PRS.0000000000003354.
Lymphaticovenular anastomosis and lymphaticovenous implantation are the most popular lymphovenous shunt operations for the treatment of obstructive lymphedema. However, no study has been reported regarding direct comparison between lymphaticovenular anastomosis and lymphaticovenous implantation. This study aimed to compare postoperative patency of lymphaticovenular anastomosis and lymphaticovenous implantation using a rat model.
Twelve Wistar rats were used for the study. The rats were randomized into the lymphaticovenular anastomosis group (n = 6) or the lymphaticovenous implantation group (n = 6). In the lymphaticovenular anastomosis group, the largest femoral lymphatic vessel was anastomosed to a similar-size vein in an end-to-end intima-to-intima coaptation manner, and the other lymphatics were ligated. In the lymphaticovenous implantation group, the femoral lymphatic vessel and surrounding tissue were inserted into the short saphenous vein with a telescopic anastomosis technique. Patency was evaluated intraoperatively and 1 week postoperatively with patent blue dye and indocyanine green lymphography.
The mean diameters of the lymphatic vessels and the veins were 0.242 mm (range, 0.20 to 0.35 mm) and 0.471 mm (range, 0.30 to 0.75 mm), respectively. Intraoperative patency was 100 percent (six of six) in both groups (p = 1.000). Postoperative patency was significantly higher in the lymphaticovenular anastomosis group compared with the lymphaticovenous implantation group [100 percent (six of six) versus 33.3 percent (two of six); p = 0.014] CONCLUSION:: Postoperative patency of the lymphaticovenular anastomosis group was higher than that of the lymphaticovenous implantation group, although intraoperative patency rates of the lymphaticovenular anastomosis and lymphaticovenous implantation groups were comparable.
淋巴管静脉吻合术和淋巴管静脉植入术是治疗阻塞性淋巴水肿最常用的淋巴静脉分流手术。然而，尚未有关于淋巴管静脉吻合术和淋巴管静脉植入术直接比较的研究报道。本研究旨在使用大鼠模型比较淋巴管静脉吻合术和淋巴管静脉植入术后的通畅率。
12只Wistar大鼠用于本研究。大鼠被随机分为淋巴管静脉吻合术组（n = 6）或淋巴管静脉植入术组（n = 6）。在淋巴管静脉吻合术组中，将最大的股淋巴管以端对端内膜对内膜贴合的方式与大小相似的静脉进行吻合，其他淋巴管予以结扎。在淋巴管静脉植入术组中，采用套叠吻合技术将股淋巴管及其周围组织插入小隐静脉。术中及术后1周用专利蓝染料和吲哚菁绿淋巴管造影评估通畅情况。
淋巴管和静脉的平均直径分别为0.242 mm（范围0.20至0.35 mm）和0.471 mm（范围0.30至0.75 mm）。两组术中通畅率均为100%（6/6）（p = 1.000）。淋巴管静脉吻合术组术后通畅率显著高于淋巴管静脉植入术组[100%（6/6）对33.3%（2/6）；p = 0.014]。结论：尽管淋巴管静脉吻合术组和淋巴管静脉植入术组术中通畅率相当，但淋巴管静脉吻合术组术后通畅率高于淋巴管静脉植入术组。
