3D脱目镜下行颈深淋巴管-静脉引流术治疗老年认知障碍患者一例疗效初步观察  

Preliminary observation of deep cervical lymphatic-venous anastomosis under off-eyepiece 3D microscope to treat an elderly patient with cognitive impairment

作　　者：卢鸿瑞[1] 谭云飞[2] 谢庆平 LU Hongrui;TAN Yunfei;XIE Qingping(Center for Plastic and Reconstructive Surgery,Department of Hand and Reconstructive Surgery,Zhejiang Provincial People’s Hospital(Affiliated People’s Hospital,Hangzhou Medical College),Hangzhou 310014,China;Department of Psychiatry,Zhejiang Provincial People’s Hospital(Affiliated People’s Hospital,Hangzhou Medical College),Hangzhou 310014,China;Department of Microsurgery,Hangzhou Qiushi Hospital,Hangzhou 310022,China)

机构地区：[1]浙江省人民医院,杭州医学院附属人民医院整形外科中心,手外科和修复重建外科,杭州310014 [2]浙江省人民医院,杭州医学院附属人民医院临床心理科,杭州310014 [3]杭州求是医院显微外科,杭州310022

出　　处：《中华显微外科杂志》2022年第5期570-574,共5页Chinese Journal of Microsurgery

摘　　要：2020年9月,杭州求是医院显微外科收治1例老年认知障碍(CI)患者。该患者术前卧床,不能正确对答,术前简易精神量表(MMSE)评分为3分(3/30),蒙特利尔认知评估(MoCA)量表评分2分(2/30)。完善术前检查后在双侧颈部Va淋巴结分区处采用3D脱目镜下结合荧光示踪技术进行颈深淋巴管-静脉吻合治疗:左侧吻合2处,分别为淋巴管-静脉端侧吻合与淋巴管-静脉端端吻合各1处;右侧进行1处淋巴管-静脉端侧吻合;所有吻合的扩张淋巴管管径均小于0.2 mm,端侧、端端吻合的静脉管径分别为0.6 mm和0.2 mm。术后常规抗炎治疗和进行脑功能康复。术后患者未出现手术并发症,切口愈合好。术后3、30、90、180 d随访,MMSE评分分别为8、12、14、18分,MoCA评分分别为8、9、11、13分。术后9个月恢复基本认知功能。In September 2020,an elderly patient with cognitive impairment(CI)was admitted in Deparment of Microsurgery,Hangzhou Qiushi Hospital.The patient was in bed and could not answer correctly before surgery.The preoperative Minimum Mental State Examination(MMSE)score was 3(3/30)and the Montreal Cognitive Assessment(MoCA)score was 2(2/30).After completion of preoperative examinations,a 3D microscope combined with fluorescence tracing technique was used to perform deep cervical lymphatic-venous anastomosis at the bilateral cervical Va lymph nodes part:two anastomosis methods were performed,one was end to side anastomosis and the other was end to end anastomosis.The diameters of all anastomotic dilated lymphatic vessels were less than 0.2 mm,the diameters of end-to-side,end to end anastomotic veins were 0.6 mm and 0.2 mm.Short-term postoperative anti-inflammatory treatment was given and a long-term functional rehabilitation training was performed.There were no postoperative complications and the incision healed well.The MMSE scores were 8,12,14,18 point,and the MoCA scores were 8,9,11,13 point.At 3,30,90,180 days after surgery,respectively.Basic cognitive function was restored at 9 months after surgery.

关 键 词：认知障碍 颈深淋巴管-静脉吻合 脱目镜三维可视技术 淋巴荧光示踪技术 

分 类 号：R749.1[医药卫生—神经病学与精神病学]