摘要
目的 探讨为阻塞性淋巴水肿的临床治疗提供更有效的显微外科治疗方法。 方法 制作兔一侧后肢淋巴水肿动物模型 60例 ,随机分为筋膜瓣治疗组 2 0只 (A组 ) ,非治疗组 2 0只 (B组 )和淋巴管 静脉吻合治疗组 2 0只作为对照 (C组 ) ;A组动物手术切取正常后肢内侧静脉后行支及其两侧约 3 0cm宽的筋膜条 (含伴行淋巴管 )移植于患肢阻塞区 ,将两静脉断端吻合于阻塞区两侧的静脉 ,分层缝合 ,注意保温 ,B组动物不经任何治疗 ,C组行淋巴管 静脉吻合术 ;术后定期测量体积变化并行淋巴核素造影。 结果 ( 1)A组在 2周以后患肢体积持续下降 ,逐渐向B组动物的正常肢体靠拢而远离B组患肢曲线 ;( 2 )A组供肢体积在 4周以后与B组健肢曲线接近 ,无继发性淋巴水肿发生 ;( 3 )术后 2 4周A组患肢体积与C组差异显著 ,疗效好于C组 ;( 4 )术后 2 4周A组患肢淋巴核素造影较B和C组患肢淋巴引流明显好转 ,核素淤积减轻。 结论 实验证明 ,静脉 淋巴管 脂肪筋膜瓣移植术的优点是 :技术难度降低 ,远期疗效肯定 ,不易引起供区慢性淋巴水肿 ,适应证较广泛。
Objective To provide a more effective microsurgical treatment for obstructive lymphedema. Methods Sixty rabbits models with lymphedema in right hindlimb were devided into three groups: 20 for fascial flap transplantation (A group), 20 for no treatment (B group) and 20 for anastomosis of lymph vessels and vein (C group) as control. For group A, the posterior branch of medial vein in the normal hindlimb was cut down together with the fascial strip (about 3cm wide) around it and concomitant lymph vessels, then transferred through the block region of the affected limb. The two broken tips of vein were anastomosed respectively to normal veins beside the block region. The subcutaneous tissue and skin were sutured at last. Be careful to keep warm. For group B, no treatment was carried out. But traditional anastomosis of lymph vessels and vein was used for group C. Postoperative difference of volume were measured regularly and lymphoscintigraphic image was made. Results (1) The volume curve of the affected limb of group A kept declining after 2 weeks and nearing to that of the normal hindlimb in group B but away from That of the affected limb in group B. (2) The curve of donor limb of group A was similar to that of the normal limb in group B, which means no secondary lymphedema occurred. (3) The volume of the affected limb of group A had significant difference to that of group C at postoperative 24 weeks, which meant the effect of group A was better than C. (4) The lymphatic drainage of the affected limb of group A was obviously better than B and C in lymphoscintigraphic image. Deposit of nuclei was lessened. Conclusion The experiment verified that the transplantation of vein-lymph vessels-fatty fascial flap had these advantages: decreased technical difficulty, better long-term effect, almost no chronic lymphedema occurred in donor site, extensive adaptation.
出处
《中华显微外科杂志》
CSCD
北大核心
2003年第3期201-203,共3页
Chinese Journal of Microsurgery
基金
上海市教委青年基金项目 (2 0 0 0QN83)
