Nuri Takashi, Asaka Akinori, Otsuki Yuki, Ueda Koichi
From the Department of Plastic and Reconstructive Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan.
Plast Reconstr Surg Glob Open. 2023 Oct 4;11(10):e5308. doi: 10.1097/GOX.0000000000005308. eCollection 2023 Oct.
Clinical studies have reported that lymphaticovenular anastomosis (LVA) is more effective for early-stage lymphedema. However, the diameter of lymphatic vessels in early-stage lymphedema is thin (only about 0.3 mm). In this article, we report a modified preparatory intravascular stenting technique (PIST) for LVA with smaller lymphatic vessels and present the results of its application for the treatment of secondary lymphedema. In this technique, a 9-0 nylon thread is inserted into the target lymphatic vessel. Then, the thread is pulled until its tip has entered the lymphatic vessel. After that, the thread is allowed to proceed into the lumen by pushing it. Finally, with the nylon in place, the lymphatic vessel is transected and the lumen is secured. In this report, we investigated the surgical time for LVA between 10 patients who underwent LVA with modified PIST (group A) and another group of 10 patients who underwent LVA without the technique (group B). Lymphatic lumen was secured at all sites where indocyanine green lymphangiography confirmed lymphatic flow. The average outer diameter of lymphatic vessels in group A and B were 0.36 mm and 0.53 mm, respectively. The average surgical time for LVA in group A was 136 minutes, which was significantly shorter than the 187 minutes in group B. Our results indicated that modified PIST can help secure the lymphatic lumen even when the lymphatic vessels are thin. As a result, this technique can significantly reduce the surgical time for this procedure.
临床研究报告称，淋巴管静脉吻合术（LVA）对早期淋巴水肿更有效。然而，早期淋巴水肿中淋巴管的直径很细（仅约0.3毫米）。在本文中，我们报告了一种针对较小淋巴管的改良血管内支架置入术（PIST）用于LVA，并展示了其应用于治疗继发性淋巴水肿的结果。在该技术中，将一根9-0尼龙线插入目标淋巴管。然后，拉动该线直至其尖端进入淋巴管。之后，通过推动使该线进入管腔。最后，尼龙线就位后，切断淋巴管并固定管腔。在本报告中，我们调查了10例接受改良PIST进行LVA的患者（A组）与另一组10例未采用该技术进行LVA的患者（B组）之间LVA的手术时间。在吲哚菁绿淋巴管造影证实有淋巴流动的所有部位，淋巴管腔均得到固定。A组和B组淋巴管的平均外径分别为0.36毫米和0.53毫米。A组LVA的平均手术时间为136分钟，明显短于B组的187分钟。我们的结果表明，即使淋巴管很细，改良PIST也有助于固定淋巴管腔。因此，该技术可显著缩短此手术的时间。
