Struick van Bemmelen S P, Olthuis G A, Dinkelman R J
Department of Surgery, Zuiderziekenhuis, Rotterdam, The Netherlands.
Neth J Surg. 1988 Jun;40(3):64-8.
The results are presented of 22 reconstructive operations in 22 patients with venous and/or lymphatic oedema of the leg, after a maximum follow-up of three years. An overall patency rate of venous anastomoses of 92% and symptomatic improvement in 75% after lymphovenous anastomoses, indicates that there is a place for reconstruction in a highly selected group of cases. Deep venous insufficiency is diagnosed by transbrachial descending phlebography and direct venous pressure determination. Mixed forms of oedema, i.e. combined venous and secondary lymphatic, frequently occur in patients who have undergone tumour resections and radiotherapy. Both non-invasive plethysmography and routine phlebography via venipuncture on the dorsum of the foot are not reliable in diagnosing mixed oedema. For adequate visualization, direct puncture of the femoral vein in the groin is recommended.
本文呈现了对22例腿部静脉和/或淋巴水肿患者进行的22次重建手术的结果，最长随访期为三年。静脉吻合的总体通畅率为92%，淋巴静脉吻合术后75%的患者症状得到改善，这表明在经过严格筛选的病例组中，重建手术有其应用价值。通过经肱静脉下行静脉造影和直接静脉压测定来诊断深静脉功能不全。混合性水肿，即静脉性和继发性淋巴性水肿合并出现，常见于接受过肿瘤切除和放疗的患者。非侵入性体积描记法和常规的经足背静脉穿刺静脉造影在诊断混合性水肿时均不可靠。为获得充分的显影效果，建议在腹股沟处直接穿刺股静脉。
