超显微淋巴管静脉吻合术的最佳部位：840 例下肢淋巴水肿患者手术野淋巴管检出率分析。
Optimal Sites for Supermicrosurgical Lymphaticovenular Anastomosis: An Analysis of Lymphatic Vessel Detection Rates on 840 Surgical Fields in Lower Extremity Lymphedema Patients.
机构信息
From the Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine; the Department of Plastic Surgery, Tokyo Metropolitan Bokutoh Hospital; and the Department of Plastic and Reconstructive Surgery, University of Tokyo Hospital.
出版信息
Plast Reconstr Surg. 2018 Dec;142(6):924e-930e. doi: 10.1097/PRS.0000000000005042.
BACKGROUND
Supermicrosurgical lymphaticovenular anastomosis is becoming a useful treatment option for progressive lower extremity lymphedema because of its minimal invasiveness. Finding a lymphatic vessel is a minimum requirement for lymphaticovenular anastomosis surgery, but no study has reported comprehensive analysis on factors associated with lymphatic vessel detection.
METHODS
One hundred thirty-four female secondary lower extremity lymphedema patients who underwent indocyanine green lymphography and lymphaticovenular anastomosis without a history of lymphedema surgery were included. Medical charts were reviewed to obtain clinical, indocyanine green lymphographic, and intraoperative findings. Lymphatic vessel detection was defined as positive when one or more lymphatic vessels were found in a surgical field of lymphaticovenular anastomosis. Logistic regression analysis was used to identify independent factors associated with lymphatic vessel detection.
RESULTS
Patient age ranged from 36 to 81 years, duration of edema ranged from 3 to 324 months, and body mass index ranged from 16.2 to 33.3 kg/m. Forty-eight patients (35.8 percent) had a history of radiation therapy, and 76 patients (56.7 percent) had a history of cellulitis. Lymphaticovenular anastomoses were performed in 840 surgical fields, among which lymphatic vessel detection was positive in 807 fields; the overall lymphatic vessel detection rate was 96.1 percent. Multivariate analysis revealed inverse associations in higher body mass index (OR, 0.323; p = 0.008) and the S-region/D-region on indocyanine green lymphography compared with the L-region (OR, 1.049 × 10(-8)/1.724 × 10(-9); p < 0.001/p < 0.001).
CONCLUSIONS
Independent factors associated with lymphatic vessel detection were clarified. Lower body mass index and L-region on indocyanine green lymphography are favorable conditions for finding lymphatic vessels in lower extremity lymphedema patients.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
背景
由于超显微淋巴管静脉吻合术具有微创性，因此成为治疗进行性下肢淋巴水肿的一种有用的治疗选择。寻找淋巴管是淋巴管静脉吻合术的最低要求，但尚无研究报告与淋巴管检测相关的综合分析因素。
方法
纳入 134 例女性继发性下肢淋巴水肿患者，这些患者均未行过淋巴水肿手术且接受过吲哚菁绿淋巴造影和淋巴管静脉吻合术。对病历进行回顾性分析，以获得临床、吲哚菁绿淋巴造影和术中的发现。当在淋巴管静脉吻合术的手术视野中发现 1 条或多条淋巴管时，将淋巴管检测定义为阳性。采用逻辑回归分析确定与淋巴管检测相关的独立因素。
结果
患者年龄 3681 岁，水肿病程 3324 个月，体重指数 16.2~33.3 kg/m2。48 例（35.8%）患者有放疗史，76 例（56.7%）患者有蜂窝织炎病史。在 840 个手术视野中进行了淋巴管静脉吻合术，其中 807 个视野检测到淋巴管，总淋巴管检测率为 96.1%。多变量分析显示，与 L 区相比，较高的体重指数（OR，0.323；p = 0.008）和吲哚菁绿淋巴造影的 S 区/D 区（OR，1.049×10(-8)/1.724×10(-9)；p < 0.001/p < 0.001）与淋巴管检测呈负相关。
结论
明确了与淋巴管检测相关的独立因素。较低的体重指数和吲哚菁绿淋巴造影的 L 区是下肢淋巴水肿患者寻找淋巴管的有利条件。
临床问题/证据水平：风险，III 级。
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