From the Division of Plastic and Reconstructive Surgery, Department of Surgery, and Departments of Anesthesiology, Diagnostic Radiology, Radiation Oncology, and Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University; Lymphedema and Reconstructive Surgery Section, Department of Breast Center, Kameda Medical Center and Kameda Kyobashi Clinic; and Departments of Plastic and Reconstructive Surgery and Anesthesiology, Xiamen Changgung Hospital.
Plast Reconstr Surg. 2022 Jan 1;149(1):237-246. doi: 10.1097/PRS.0000000000008674.
Functional lymphatic vessels are essential for supermicrosurgical lymphaticovenous anastomosis. Theoretically, the larger the lymphatic vessel, the better the flow. However, large lymphatic vessels are not readily available. Since the introduction of lymphaticovenous anastomosis, no guidelines have been set as to how small a lymphatic vessel is still worthwhile for anastomosis.
In this longitudinal cohort study, unilateral lower limb lymphedema patients who underwent lymphaticovenous anastomosis between March of 2016 and January of 2019 were included. Demographic data and intraoperative findings including the number and size of lymphatic vessels were recorded. The cutoff size was determined by receiver operating characteristic curve analysis, based on the functional properties of lymphatic vessels. Clinical correlation was made with post-lymphaticovenous anastomosis volume measured by magnetic resonance volumetry.
A total of 141 consecutive patients (124 women and 17 men) with a median age of 60.0 years (range, 56.7 to 61.2 years) were included. The cutoff size for a functional lymphatic vessel was determined to be 0.50 mm (i.e., lymphatic vessel0.5) from a total of 1048 lymphatic vessels. Significant differences were found between the number of lymphatic vessels0.5 anastomosed (zero to one, two to three, and greater than over equal to four lymphatic vessels0.5), the median post-lymphaticovenous anastomosis volume reduction (in milliliters) (p < 0.001), and the median percentage volume reduction (p = 0.012).
Lymphatic vessel0.5 can be a valuable reference for lymphaticovenous anastomosis. Post-lymphaticovenous anastomosis outcome can be enhanced with the use of lymphatic vessel0.5 for anastomoses.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
功能性淋巴管对于超显微淋巴管静脉吻合术至关重要。理论上，淋巴管越大，血流越好。然而，大的淋巴管不容易获得。自从淋巴管静脉吻合术问世以来，对于仍然值得进行吻合的最小淋巴管的大小，尚无指南规定。
本研究为一项纵向队列研究，纳入了 2016 年 3 月至 2019 年 1 月期间接受淋巴管静脉吻合术的单侧下肢淋巴水肿患者。记录了患者的人口统计学数据和术中发现，包括淋巴管的数量和大小。根据淋巴管的功能特性，通过接受者操作特征曲线分析确定了截断大小。术后通过磁共振容积测量评估吻合术后的体积，并进行临床相关性分析。
共纳入 141 例连续患者（124 名女性和 17 名男性），中位年龄为 60.0 岁（范围，56.7 岁至 61.2 岁）。从总共 1048 条淋巴管中确定了功能性淋巴管的截断大小为 0.50 毫米（即淋巴管 0.5）。吻合的淋巴管 0.5 的数量（零至一、二至三、大于等于四）、术后淋巴管静脉吻合术减少的中位数（毫升）（p < 0.001）和中位数体积减少百分比（p = 0.012）之间存在显著差异。
淋巴管 0.5 可以作为淋巴管静脉吻合术的有价值的参考。通过使用淋巴管 0.5 进行吻合，可以提高术后淋巴管静脉吻合术的效果。
临床问题/证据水平：风险，II 级。
