Department of Surgery A, Galilee Medical Center, Nahariya, Israel; Faculty of Medicine of the Galilee, Bar-Ilan University, Ramat Gan, Israel.
Medical Corps, Israel Defense Forces, Ramat Gan, Israel.
J Vasc Surg Venous Lymphat Disord. 2021 Jan;9(1):226-233.e1. doi: 10.1016/j.jvsv.2020.04.025. Epub 2020 May 21.
The objective of this study was to evaluate the efficacy and safety of lymphaticovenular anastomosis (LVA) in patients with lymphedema.
A retrospective analysis was conducted of 70 patients suffering from primary or secondary lymphedema who underwent LVA surgery with indocyanine green fluorescence lymphangiography. Postoperative evaluation included qualitative and quantitative volumetric assessment and analysis. Limb volume was measured by circumferential tape measurement volumetric method, in which the limb is subdivided into five segments and each segment's circumference is measured.
LVA was performed in 70 patients, 22 with primary lymphedema and 48 with secondary lymphedema. The difference in preoperative upper limb volume was 35% with mean postoperative follow-up of 9 months. The mean number of lymphovenous bypasses was 3.9. The reduction in limb volume at 3, 6, and 12 months was 40.4%, 41%, and 45%, respectively. Patients with early-stage lymphedema had significantly higher volume reductions than patients with late-stage lymphedema at 3, 6, and 12 months (48% vs 18%, 49% vs 22%, and 65% vs 31%; P < .001). For lower extremity lymphedema, the preoperative volume differential was 25.5%. The mean postoperative follow-up was 9 months. The reduction in limb volume at 3, 6, and 12 months was 28%, 37%, and 39%, respectively.
LVA surgery is a safe and effective method of reducing lymphedema severity, especially in upper extremity lymphedema at an earlier disease stage.
本研究旨在评估淋巴管静脉吻合术（LVA）治疗淋巴水肿的疗效和安全性。
对 70 例原发性或继发性淋巴水肿患者进行回顾性分析，这些患者均接受了吲哚菁绿荧光淋巴管造影引导下的 LVA 手术。术后评估包括定性和定量体积评估分析。肢体体积采用周长带测量体积法测量，即将肢体分为五个节段，分别测量每个节段的周长。
70 例患者接受了 LVA 手术，其中 22 例为原发性淋巴水肿，48 例为继发性淋巴水肿。术前上肢体积差异为 35%，平均术后随访 9 个月。平均吻合淋巴管静脉旁路数为 3.9 条。术后 3、6 和 12 个月的肢体体积减少率分别为 40.4%、41%和 45%。早期淋巴水肿患者在术后 3、6 和 12 个月的体积减少率明显高于晚期患者（48%比 18%、49%比 22%和 65%比 31%；P<.001）。下肢淋巴水肿患者术前体积差异为 25.5%，平均术后随访 9 个月。术后 3、6 和 12 个月的肢体体积减少率分别为 28%、37%和 39%。
LVA 手术是一种安全有效的减轻淋巴水肿严重程度的方法，尤其适用于早期上肢淋巴水肿。
