静脉化淋巴结移植联合LVA治疗继发性上肢淋巴水肿  

Application of venous lymph node transplantation combined with LVA for the treatment of secondary upper limb lymphedema

作　　者：吴建龙 谢庆平 朱孜冠[1] 卢鸿瑞[1] 陈博达 杨晓东 Wu Jianlong;Xie Qingping;Zhu Ziguan;Lu Hongrui;Chen Boda;Yang Xiaodong(Zhejiang Provincial People's Hospital(Affiliated People's Hospital),Hangzhou Medical College,Hangzhou 310000,Zhejiang Province,China;Qiushi Hospital,Hangzhou 310000,Zhejiang Province,China)

机构地区：[1]浙江省人民医院,杭州医学院附属人民医院,浙江杭州310014 [2]杭州求是医院,浙江杭州310022

出　　处：《中国临床解剖学杂志》2025年第2期133-137,共5页Chinese Journal of Clinical Anatomy

基　　金：浙江省卫生厅科技计划项目(2024KY022)。

摘　　要：目的探讨静脉化淋巴结移植(Venous lymph node transplantation,VLNT)联合淋巴静脉吻合术(lymphatic vein anastomosis,LVA)治疗继发性上肢淋巴水肿的手术方法和临床疗效。方法2021年8月至2024年6月,我院通过VLNT联合LVA的治疗方式治疗16例继发性上肢淋巴水肿患者。所有患者术前进行患肢臂围周径的测量,从腕部至腋窝每间隔5 cm测量1次,记录数据。所有患者术前均需行高频彩色多普勒超声淋巴检查和吲哚菁绿(ICG)近红外淋巴成像检查,定位标记肢体功能性淋巴管和腋窝处淋巴液堵塞区域。切取含浅静脉血管的腹股沟淋巴结组织瓣(3~4个淋巴结),移植至患肢腋窝处行浅静脉与受区静脉进行flow-through吻合。结合多位点的淋巴静脉吻合术,根据术前淋巴定位,选择多位点横行小切口(2~3 cm)切开皮肤至脂肪层,显微镜下选择功能性淋巴管与皮下浅静脉吻合。术后测量患肢上肢臂围周径并记录。结果16例患者均为单侧上肢淋巴水肿,年龄(52~78)岁;所有患者切口均愈合良好。随访时间(6~24)月(平均12月),患肢水肿均较术前明显减轻,患肢不同平面的测量周径均较术前明显减少(P<0.05)。上肢活动功能较术前改善,患者对恢复满意。结论静脉化淋巴结移植联合肢体淋巴静脉吻合术治疗继发性上肢淋巴水肿,能够明显减轻肢体水肿,改善肢体功能,取得较满意的治疗效果。Objective To explore the surgical method and clinical efficacy of venous lymph node transplantation(VLNT)combined with lymphatic vein anastomosis(LVA)for the treatment of secondary upper limb lymphedema.Methods From August 2021 to June 2024,our hospital treated 16 patients with secondary upper limb lymphedema using venous lymph node transplantation(VLNT)combined with LVA.All patients underwent preoperative measurements of the circumference of both upper limb arms,with measurements taken every 5cm from the wrist to the axilla,and data was recorded.All patients underwent high-frequency color Doppler ultrasound lymphatic examination and indocyanine green(ICG)near-infrared lymphatic imaging examination before surgery to locate and mark functional lymphatic vessels in the limbs and lymphatic obstruction areas in the axilla.The inguinal lymph node tissue flap(3-4 lymph nodes)containing superficial venous vessels were cut and transplanted to the axilla of the affected limb for flowthrough anastomosis of the superficial vein and recipient vein.Based on preoperative lymphatic vessel localization,a small longitudinal incision(2-3 cm)was made to cut through the skin to the fat layer,and functional lymphatic vessels were selected for anastomosis with subcutaneous veins under a microscope.The circumference of the upper limb arm of the affected limb after surgery was measured and recorded using the same method.Results All 16 patients had unilateral upper limb lymphedema,aged 52-78 years old.All patient incisions healed well.The follow-up period was 6-24 months(average 12 months),and the edema of the affected limb was significantly reduced before surgery.The measured circumference of the affected limb in different planes was significantly reduced compared to before surgery(P<0.05).The upper limb activity function has improved compared to before surgery,and the patient was satisfied with the recovery.Conclusions The combination of venous lymph node transplantation and LVA treatment for secondary upper limb lymphedema can signifi

关 键 词：淋巴水肿 静脉化淋巴结移植 淋巴静脉吻合 

分 类 号：R616.2[医药卫生—外科学]