Department of Plastic and Reconstructive Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan; Department of Plastic and Reconstructive Surgery, Shonan Atsugi Hospital, 118-1 Nurumizu, Atsugi, Kanagawa 243-8551, Japan.
Department of Plastic and Reconstructive Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan.
J Plast Reconstr Aesthet Surg. 2019 Jan;72(1):62-70. doi: 10.1016/j.bjps.2018.09.005. Epub 2018 Sep 20.
Lymphaticovenular anastomosis (LVA) is generally an effective procedure for breast cancer treatment-related upper extremity lymphedema (UEL). Clinical improvement is, however, limited by the degree of sclerosis of the lymphatic vessels. We have developed a method by which we use dynamic ultrasonography to depict vessels through which lymph can be propelled into the LVA under the power of the patient's natural hand movements.
We assessed the dynamic-LVA method by comparing clinical details of 15 cases of breast cancer treatment-related lymphedema treated by dynamic LVA and 15 corresponding cases treated by conventional LVA.
Placement of incisions at a total of 90 forearm sites (three per patient) yielded 90 LVAs (32 in "linear ICG lymphography pattern incisions" and 58 in "stardust pattern incisions"). Sclerotic lymphatic vessels were encountered at greater frequency in "linear pattern incisions" in the dynamic LVA group than in the conventional LVA group (7.1% vs. 38.9%, P = 0.030). Postoperative volume reduction was significantly greater in the dynamic LVA group than in the conventional LVA group; the UEL index at 1 month was 8.12 ± 3.08 vs. 3.74 ± 5.82, respectively (P = 0.018), and at 1 year was 10.23 ± 6.16 vs. 2.03 ± 9.36, respectively (P = 0.014).
Dynamic LVA is clinically beneficial because the imaging guides decisions over the locations where the incisions should be placed so that a patient's natural hand motions can be used to propel lymph into the anastomosis despite the presence of sclerosis and because even early improvements are obtained.
淋巴管静脉吻合术（LVA）通常是治疗乳腺癌相关上肢淋巴水肿（UEL）的有效方法。然而，临床改善受到淋巴管硬化程度的限制。我们开发了一种方法，通过该方法，我们使用动态超声来描绘在患者自然手部运动的推动下可以将淋巴推入 LVA 的血管。
我们通过比较 15 例乳腺癌治疗相关淋巴水肿患者接受动态 LVA 和 15 例接受常规 LVA 治疗的临床细节，评估了动态-LVA 方法。
在手前臂总共 90 个部位（每个患者 3 个部位）进行切口，共获得 90 个 LVA（32 个在“线性 ICG 淋巴管造影模式切口”，58 个在“星爆模式切口”）。在动态 LVA 组中，与常规 LVA 组相比，“线性模式切口”中遇到的硬化淋巴管更为常见（7.1%比 38.9%，P=0.030）。动态 LVA 组的术后体积减少明显大于常规 LVA 组；1 个月时 UEL 指数分别为 8.12±3.08 和 3.74±5.82（P=0.018），1 年时分别为 10.23±6.16 和 2.03±9.36（P=0.014）。
动态 LVA 在临床上是有益的，因为成像可以指导切口的位置决策，以便可以利用患者的自然手部运动将淋巴推入吻合处，尽管存在硬化，但即使早期也可以获得改善。
