From the Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine.
Plast Reconstr Surg. 2019 Aug;144(2):486-496. doi: 10.1097/PRS.0000000000005870.
Lymphovenous anastomosis is technically challenging and can be successfully performed with an advanced operating microscope, supermicrosurgical instruments, and indocyanine green lymphography. This study compared the outcomes between side-to-end and end-to-end lymphovenous anastomosis configurations for unilateral extremity lymphedema.
Between April of 2013 and June of 2017, lymphovenous anastomosis was indicated for 58 patients who preoperatively had patent lymphatic ducts by indocyanine green lymphography, including 20 patients with upper limb lymphedema and 38 patients with lower limb lymphedema. Either an end-to-end or a side-to-end lymphovenous anastomosis was used to anastomose the subdermal venule to the lymphatic duct. The circumferential difference and episodes of cellulitis were used as outcome measurements.
Twenty-three patients underwent an end-to-end lymphovenous anastomosis and 35 patients underwent side-to-end lymphovenous anastomosis. All patients had an immediate patency evaluated by indocyanine green lymphography and patent blue assessments. All patients returned to their daily routine without the use of any compression garments. At an average follow-up of 16.5 months (range, 13.4 to 19.6 months), the improvement of circumferential difference (3.2 percent; range, 1.8 to 4.6 percent) in the side-to-end group was statistically greater than that in the end-to-end group (2.2 percent; range, 1 to 3.4 percent; p = 0.04). The overall episodes of cellulitis were significantly reduced from 1.7 times/year (range, 1.3 to 2.1 times/year) to 0.7 times/year (range, 0.3 to 1.1 times/year; p < 0.001), but no difference was observed between the two groups.
Both side-to-end and end-to-end lymphovenous anastomosis configurations were effective surgical approaches for improving early-grade extremity lymphedema. Side-to-end lymphovenous anastomosis has the advantages of having greater efficacy for lymph drainage, requiring only one anastomosis and eliminating the need to use compression garments.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
淋巴管静脉吻合术技术难度大，在先进的手术显微镜、超微外科器械和吲哚菁绿淋巴造影的辅助下可以成功实施。本研究比较了用于单侧肢体淋巴水肿的端侧吻合和端端吻合在淋巴管静脉吻合术中的效果。
2013 年 4 月至 2017 年 6 月，对 58 例术前吲哚菁绿淋巴造影显示淋巴管通畅的患者进行了淋巴管静脉吻合术，其中上肢淋巴水肿 20 例，下肢淋巴水肿 38 例。采用端侧或端端淋巴管静脉吻合术将皮下小静脉与淋巴管吻合。以周径差和蜂窝织炎发作为结局测量指标。
23 例行端端淋巴管静脉吻合术，35 例行端侧淋巴管静脉吻合术。所有患者均行吲哚菁绿淋巴造影和专利蓝评估即刻通畅性。所有患者均未使用任何加压包扎即恢复日常活动。平均随访 16.5 个月（范围，13.4 至 19.6 个月），侧侧组周径差改善（3.2%；范围，1.8%至 4.6%）显著大于端端组（2.2%；范围，1%至 3.4%；p=0.04）。两组间总体蜂窝织炎发作次数均显著减少（从每年 1.7 次[范围，1.3 至 2.1 次/年]降至每年 0.7 次[范围，0.3 至 1.1 次/年]；p<0.001），但两组间无差异。
端端吻合和侧侧吻合在改善早期肢体淋巴水肿方面均为有效的手术方法。侧侧吻合在淋巴管引流方面效果更佳，只需吻合一处，且无需使用加压包扎。
临床问题/证据水平：治疗性，III 级。
