Mihara Makoto, Hara Hisako, Kawakami Yoshihisa, Zhou Hang Peng, Tange Shuichi, Kikuchi Kazuki, Iida Takuya
Department of Lymphatic and Reconstructive Surgery, Saiseikai Kawaguchi General Hospital, Saitama, Japan; Department of Plastic and Reconstructive Surgery, Fukuoka University, Fukuoka, Japan; Department of Plastic and Reconstructive Surgery, Nadogaya Hospital, Chiba, Japan.
Department of Lymphatic and Reconstructive Surgery, Saiseikai Kawaguchi General Hospital, Saitama, Japan.
J Plast Reconstr Aesthet Surg. 2018 Feb;71(2):e1-e7. doi: 10.1016/j.bjps.2017.10.004. Epub 2017 Oct 17.
The method of lymphatic venous anastomosis (LVA), including its indications or preoperative examinations, has not been established. The purpose of this study is to reveal the possible application of preoperative echography in surgical LVA outcome.
We performed a retrospective case-control study on patients with lower limb lymphedema who underwent LVA between August 15, 2013 and August 15, 2014. As a preoperative examination, we used venous echography to identify subcutaneous veins in the echo group, while we only used Accuvein visualizing system in the control group. The operation time, number of anastomoses, and limb circumference were compared between the two groups.
Seventeen patients (34 limbs) were included in the echo group, and 21 patients (42 limbs) were included in the control group. The average follow-up period was 11.9 (6-16) and 12.4 (6-27) months, respectively. The average operation time in the echo group was 258.6 min, and that in the control group was 216.5 min. The average number of anastomoses was 9.8 and 7.0 in the echo and control group, respectively. The average time per anastomosis was 27.4 and 32.6 min, respectively. The diameter of the vein had a tendency to be larger in the echo group than in the control group. In 5.8% of the echo group, we observed a circumference increase, compared with 23.8% in the control group.
Preoperative venous echography allowed surgeons to increase the number of anastomoses performed within the operating time, resulting in improvement of surgical outcomes.
淋巴管静脉吻合术（LVA）的方法，包括其适应症或术前检查，尚未确立。本研究的目的是揭示术前超声检查在LVA手术结果中的可能应用。
我们对2013年8月15日至2014年8月15日期间接受LVA手术的下肢淋巴水肿患者进行了一项回顾性病例对照研究。作为术前检查，我们在超声检查组中使用静脉超声检查来识别皮下静脉，而在对照组中仅使用Accuvein可视化系统。比较两组的手术时间、吻合数量和肢体周长。
超声检查组纳入17例患者（34条肢体），对照组纳入21例患者（42条肢体）。平均随访期分别为11.9（6 - 16）个月和12.4（6 - 27）个月。超声检查组的平均手术时间为258.6分钟，对照组为216.5分钟。超声检查组和对照组的平均吻合数量分别为9.8和7.0。每次吻合的平均时间分别为27.4分钟和32.6分钟。超声检查组的静脉直径有大于对照组的趋势。超声检查组中有5.8%观察到周长增加，而对照组为23.8%。
术前静脉超声检查使外科医生能够在手术时间内增加吻合数量，从而改善手术结果。
