Yoshida Shuhei, Imai Hirofumi, Roh Solji, Mese Toshiro, Koshima Isao
Department of Plastic and Reconstructive Surgery, The International Center for Lymphedema, Hiroshima University Hospital, Hiroshima, Japan.
Plast Reconstr Surg Glob Open. 2022 May 24;10(5):e4348. doi: 10.1097/GOX.0000000000004348. eCollection 2022 May.
Several treatment options, including sclerotherapy and surgical excision, are available for the management of cystic lymphangioma. Lymphaticovenular anastomosis (LVA) has recently garnered attention in the field of microsurgery as a minimally invasive surgical reconstruction strategy. Combined treatment using surgical excision and LVA for large or persistent cystic lymphatic malformations has been reported but can be very invasive. This case report describes use of a combination of LVA and sclerotherapy to treat cystic lymphatic malformations with satisfactory results. This combination could be a complementary minimally invasive treatment for extensive cystic lymphatic malformations. The patient was an 18-year-old woman with a cystic lymphangioma from the axilla to the subclavicular area beneath pectoralis major and pectoralis minor. The size was a diameter of 12 cm and a maximum depth of 8 cm. The cystic lymphangioma was managed by combined treatment of LVA and ethanol sclerotherapy. The patient had subsequent resolution of the lymphangioma without any symptoms of lymphedema or recurrence. LVA is thought to be a less invasive treatment option when the lymphatics flowing into a cyst are detectable or can be targeted. However, this is not always the case, especially if the cyst is large, persistent, or infected. Combination of LVA with sclerotherapy is a relatively less invasive method with closure of the dead space using sclerotherapy without further exacerbation or occurrence of lymphedema. Therefore, combined treatment using LVA with sclerotherapy can be a complementary minimally invasive treatment option for a large or persistent lymphocele.
包括硬化治疗和手术切除在内的多种治疗方案可用于囊性淋巴管瘤的管理。淋巴静脉吻合术（LVA）作为一种微创外科重建策略，最近在显微外科领域受到了关注。已有报道采用手术切除和LVA联合治疗大型或持续性囊性淋巴管畸形，但这种方法可能具有很高的侵入性。本病例报告描述了使用LVA和硬化治疗联合治疗囊性淋巴管畸形，取得了满意的效果。这种联合治疗可能是广泛囊性淋巴管畸形的一种补充性微创治疗方法。患者为一名18岁女性，患有从腋窝至胸大肌和胸小肌下方锁骨下区域的囊性淋巴管瘤。其大小为直径12厘米，最大深度8厘米。该囊性淋巴管瘤通过LVA和乙醇硬化治疗联合进行处理。患者随后淋巴管瘤消退，未出现任何淋巴水肿或复发症状。当流入囊肿的淋巴管可检测到或可靶向时，LVA被认为是一种侵入性较小的治疗选择。然而，情况并非总是如此，尤其是当囊肿较大、持续存在或发生感染时。LVA与硬化治疗联合是一种相对侵入性较小的方法，通过硬化治疗封闭死腔，不会进一步加重或引发淋巴水肿。因此，LVA与硬化治疗联合可作为大型或持续性淋巴囊肿的一种补充性微创治疗选择。
