Karakawa Ryo, Yoshimatsu Hidehiko, Kamiya Keisuke, Fuse Yuma, Yano Tomoyuki
Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan.
J Clin Med. 2021 Jun 11;10(12):2595. doi: 10.3390/jcm10122595.
Lymphaticovenular anastomosis (LVA) is a challenging procedure and requires a sophisticated supermicrosurgical technique. The aim of this study was to evaluate and establish a discrete supermicrosurgical anastomosis method using the "suture-stent technique".
Forty-eight LVA sites of twenty patients with lower extremity lymphedema who had undergone LVA between July 2020 and January 2021 were included in this study. LVA was performed with the conventional technique or with the suture-stent technique. The patency of the anastomoses was evaluated using an infrared camera system intraoperatively. The success rate on the first try and the final success rate for each group were compared.
After full application of the exclusion criteria, 35 LVAs of 16 patients including 20 limbs were included in the analysis. The ratio of good patency findings after anastomosis in the suture-stent technique group was 100%. The incidences of leakage or occlusion on the first try were statistically greater in the conventional technique group (29.4%) than in the suture-stent technique group (0%) ( = 0.0191). All anastomoses achieved good patency in the final results.
With its minimal risk of catching the back wall during the anastomosis, the suture-stent technique can be considered an optimal anastomosis option for LVA.
淋巴管静脉吻合术（LVA）是一项具有挑战性的手术，需要精湛的超显微外科技术。本研究的目的是评估并建立一种使用“缝合-支架技术”的离散超显微外科吻合方法。
本研究纳入了2020年7月至2021年1月期间接受LVA的20例下肢淋巴水肿患者的48个LVA部位。LVA采用传统技术或缝合-支架技术进行。术中使用红外摄像系统评估吻合口的通畅情况。比较每组首次尝试的成功率和最终成功率。
在充分应用排除标准后，分析纳入了16例患者（包括20条肢体）的35个LVA。缝合-支架技术组吻合术后通畅良好的比例为100%。传统技术组首次尝试时渗漏或闭塞的发生率（29.4%）在统计学上高于缝合-支架技术组（0%）（P = 0.0191）。最终结果显示所有吻合口均通畅良好。
由于吻合过程中后壁被夹住的风险最小，缝合-支架技术可被视为LVA的最佳吻合选择。
