侧侧吻合与端端吻合在继发性下肢淋巴水肿中的对比分析。
Comparative Analysis between Side-to-End and End-to-End Lymphaticovenous Anastomosis for Secondary Lower Limb Lymphedema.
机构信息
From the Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine.
出版信息
Plast Reconstr Surg. 2022 Nov 1;150(5):1138-1148. doi: 10.1097/PRS.0000000000009647. Epub 2022 Sep 2.
BACKGROUND
The purpose of this retrospective study was to describe, evaluate, and compare the outcome between end-to-end and side-to-end lymphaticovenous anastomoses for all stages of lymphedema.
METHODS
A total of 123 patients were divided into the end-to-end ( n = 63) or the side-to-end ( n = 60) group. The demographics and intraoperative and postoperative findings were evaluated. In addition, subcategory evaluation was performed for early- and advanced-phase lymphedema.
RESULTS
The demographic findings were insignificant. The intraoperative findings showed a significantly higher number of lymphaticovenous anastomoses performed for the end-to-end group (4.1 ± 1.7) over the side-to-end group (3.2 ± 1.2) ( p < 0.001), whereas the number of different lymphatic vessels used per patient was not significant (3.4 ± 1.4 versus 3.2 ± 1.2; p = 0.386). The diameter of the lymphatic vessels was not significant (0.43 ± 0.06 mm versus 0.45 ± 0.09 mm; p = 0.136). Although both groups showed significant postoperative volume reduction, the side-to-end group had a significantly better reduction in all time intervals ( p < 0.03) and longitudinal outcome ( p = 0.004). However, the subcategory evaluation for early-phase patients showed no difference between the two groups, but a significantly better volume reduction ratio was noted for the side-to-end group at all time intervals ( p < 0.025) in addition to overall longitudinal outcome ( p = 0.004) in advanced lymphedema patients.
CONCLUSIONS
This is the first study to report the efficacy of end-to-end versus side-to-end lymphaticovenous anastomosis in different phases of lymphedema. Although both end-to-end and side-to-end lymphaticovenous anastomoses are significantly effective in volume reduction, there was a significantly better reduction for the side-to-end group in advanced-phase lymphedema patients with stage II late and stage III disease, whereas no difference was noted for early-phase lymphedema patients.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
背景
本回顾性研究的目的是描述、评估并比较端对端和侧对端淋巴管静脉吻合术在所有阶段淋巴水肿中的疗效。
方法
共纳入 123 例患者，分为端对端（n=63）或侧对端（n=60）组。评估了患者的人口统计学资料、术中及术后发现。此外，对早、晚期淋巴水肿进行了亚组评估。
结果
患者的人口统计学资料无显著差异。术中发现，端对端组行淋巴管静脉吻合术的数量明显多于侧对端组（4.1±1.7 比 3.2±1.2；p＜0.001），但每位患者使用的不同淋巴管数量无显著差异（3.4±1.4 比 3.2±1.2；p=0.386）。淋巴管直径无显著差异（0.43±0.06 mm 比 0.45±0.09 mm；p=0.136）。虽然两组术后体积均显著减少，但侧对端组在所有时间间隔（p＜0.03）和纵向结果（p=0.004）上的减少更显著。然而，早期间质水肿患者的亚组评估结果显示两组之间无差异，但侧对端组在所有时间间隔（p＜0.025）和晚期淋巴水肿患者的总体纵向结果（p=0.004）上的体积减少率均显著更高。
结论
这是第一项报告端对端与侧对端淋巴管静脉吻合术在不同阶段淋巴水肿中的疗效的研究。尽管端对端和侧对端淋巴管静脉吻合术在体积减少方面均有显著效果，但在晚期淋巴水肿患者中，侧对端组在 II 期晚期和 III 期疾病患者中的减少更显著，而在早期间质水肿患者中则无差异。
临床问题/证据水平：治疗性，III 级。
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