Aim:This study aimed to clarify the efficacy of the integration of lymphaticovenular anastomosis(LVA)and perioperative reduction treatment in the exploration of optimal combination of surgery and conservative therapy ...Aim:This study aimed to clarify the efficacy of the integration of lymphaticovenular anastomosis(LVA)and perioperative reduction treatment in the exploration of optimal combination of surgery and conservative therapy for lymphedema.Methods:We conducted a retrospective chart review of 134 consecutive patients with lower extremity lymphedema who were treated with LVA.A total of 116 patients were included,and they were divided into two groups:patients who underwent perioperative reduction treatment(PORT)following LVA surgery(PORT group,51 patients)and patients who underwent no additional perioperative intervention after LVA surgery(control group,65 patients).PORT included compression therapy and remedial exercise.A total of 41 matched pairs were extracted after propensity score matching analysis.The edema reduction effect was compared between the two groups.Results:Patients who underwent PORT had a significantly higher edema reduction than those in the control group(reduction in lower extremity lymphedema index,14.7 vs.6.7;P=0.03).No unfavorable complications related to PORT were observed in our cohort.Conclusion:It would be highly beneficial to combine reduction treatment in the early postoperative period after LVA surgery to maximize treatment outcomes.展开更多
Aim:Lymphaticovenular anastomosis(LVA)is the mainstay of surgical treatment of lymphedema now.Indocyanine green(ICG)lymphography is a method for detecting lymphatic pathways and for the clinical evaluation of patients...Aim:Lymphaticovenular anastomosis(LVA)is the mainstay of surgical treatment of lymphedema now.Indocyanine green(ICG)lymphography is a method for detecting lymphatic pathways and for the clinical evaluation of patients with extremity lymphedema.The essential point of LVA is to find more functional lymphatic vessels.Sometimes,in cases of lymphatic dysfunction,ICG injections into the distal extremities are insufficient.The purpose of this study was to elucidate the effect of multi-injection of ICG lymphography on LVA.Methods:In this study,we injected ICG into the second web of the hands or the first web of the feet.In the multi-injection group,we injected additional ICG in other sites.We observed the presence or absence of a linear pattern at each injection site with a near-infrared camera.Then,we performed LVA and evaluated the circumference change and the operation time.Results:In the multi-injection group,we injected ICG into the upper limb at an average of 2.2 sites(range:1-3 sites)and the lower limb at an average of 3.2 sites(range:1-5 sites).The circumference change of upper limbs in the control group was-3.95%±1.34%and in the multi-injection group was-6.96%±0.88%(P<0.05).The change in circumference of lower limbs was-5.01%±2.2%in the multi-injection group and-2.33%±1.77%in the control group(P=0.003).The mean surgical duration was significantly shortened in the multi-injection group(P<0.05).Conclusion:By injecting ICG into multiple sites of the affected limbs,we could detect more functional lymphatic vessels during LVA,which was helpful for achieving a successful surgical result.展开更多
Lymphaticovenular anastomosis(LVA)is a highly effective,minimally invasive surgical treatment for lymphedema.The effect of LVA appears immediately after the creation of lymph-to-venous pathway.However,the long-term ou...Lymphaticovenular anastomosis(LVA)is a highly effective,minimally invasive surgical treatment for lymphedema.The effect of LVA appears immediately after the creation of lymph-to-venous pathway.However,the long-term outcome of LVA is not always promising when the lymph-to-venous anastomosis has any potential risk of occlusion.The reasons of postoperative LVA occlusions are considered both a technical matter in performing LVA and a strategic matter in preoperative planning.This report focuses on intraoperative techniques of LVA to avoid postoperative occlusions.Depending on the types of undesirable surgical procedures,lymphaticovenular anastomoses are at risk of future occlusions in early,mid-,or late-postoperative course.The authors describe fundamental and essential techniques to perform supermicrosurgical LVA,and the true concept of Isao Koshima’s supermicrosurgery,in which the pith and marrow of the doctrine is not only the way of handling the small vessels or needles,but also the surgeons’skills to feel intima of the vessels and lymphatic flow itself.展开更多
Lymphaticovenular anastomosis(LVA)is a highly effective,minimally invasive surgical treatment for lymphedema.The clinical effect of LVA begins immediately after the creation of the lymph-to-venous pathway.However,the ...Lymphaticovenular anastomosis(LVA)is a highly effective,minimally invasive surgical treatment for lymphedema.The clinical effect of LVA begins immediately after the creation of the lymph-to-venous pathway.However,the long-term effect of LVA is not always promised when the lymph-to-venous bypass has any potential risk of occlusion,especially when the disorder has reached the late stage.The reasons of postoperative LVA occlusion are considered both a technical matter in performing LVA and a strategic matter in planning LVA.This article focuses on the effective preoperative LVA planning methodology of“functional LVA”for peripheral lymphedema,in which continuous and strong lymph flow at the anastomosis is created by the muscle pumping power of patients’natural motions at the selected incision point.The current functional LVAs which we have developed are the dynamic LVA method for upper extremity lymphedema and the superior-edge-of-the-knee incision method for lower extremity lymphedema.Because these methods reduce the risk of postoperative LVA occlusion by continuous lymph-to-venous flow at the LVA,functional LVAs keep long-term clinical effect in reduction of lymphedema.展开更多
Axillary lymph node dissection-dependent chyle leakage is a rare complication with an incidence of<0.7%.The morbidity could be high,and the management prolonged and not clear.The literature offers us many therapeut...Axillary lymph node dissection-dependent chyle leakage is a rare complication with an incidence of<0.7%.The morbidity could be high,and the management prolonged and not clear.The literature offers us many therapeutical tools,yet there is no consensus about the management of this complication.Usually,the management focuses on reducing the chyle flow in the thoracic duct(central origin),neglecting the possibility of a parallel lymphorrhea from other regional lymphatic vessels(peripheral origin),which causes a prolonged approach with high morbidity.In this paper,we introduce the supermicrosurgery technique as a surgical therapeutic option for chyle leakage.To decrease morbidity and shorten treatment duration,we offer a therapeutic algorithm based on the literature and our experience.展开更多
Early surgical intervention for lymphedema can delay,prevent,and even reverse lymphatic degeneration.Vascularized lymph vessel transplant(VLVT)has emerged as an alternative to vascularized lymph node transplant(VLNT)f...Early surgical intervention for lymphedema can delay,prevent,and even reverse lymphatic degeneration.Vascularized lymph vessel transplant(VLVT)has emerged as an alternative to vascularized lymph node transplant(VLNT)for the treatment of advanced,fluid-predominant lymphedema,providing highly favorable outcomes with reduced donor-site complications.Lymphaticovenular anastomosis(LVA)has traditionally been reserved for early disease.However,technical refinements have improved its results and expanded its efficacy,creating an overlap between the indications for VLVT/VLNT and LVA.This article describes our technical approach to VLVT and LVA and explores the nuances of treatment selection in the light of their shifting indications.展开更多
The effectiveness of supermicrosurgical lymphovenous anastomosis(LVA)for lymphedema treatment remains controversial.Currently,no evidence has been summarized.This study aimed to review the published literature on supe...The effectiveness of supermicrosurgical lymphovenous anastomosis(LVA)for lymphedema treatment remains controversial.Currently,no evidence has been summarized.This study aimed to review the published literature on supermicrosurgical LVAs in the treatment of peripheral lymphedema and to analyze the surgical outcomes.Studies from databases(PubMed/MEDLINE,Cochrane Controlled Trial Data,and Embase)were collected to determine the effectiveness of supermicrosugrical LVAs for lymphedema.A systematic review was performed using individual patient data.Fifteen studies,including 578 patients(482 female,72 male,and 24 unknown)with a mean age of 51 years,satisfied the needs of the study requirements.Supermicrosurgical LVAs for peripheral lymphedema have demonstrated substantial improvements in both objective and subjective findings in many patients.Moreover,in the long-term follow-up,the effectiveness of this treatment modality maintained a high efficacy of LVA in lymphedema cases.However,most studies provided low-quality evidence,and the conclusion is still not finalized.展开更多
文摘Aim:This study aimed to clarify the efficacy of the integration of lymphaticovenular anastomosis(LVA)and perioperative reduction treatment in the exploration of optimal combination of surgery and conservative therapy for lymphedema.Methods:We conducted a retrospective chart review of 134 consecutive patients with lower extremity lymphedema who were treated with LVA.A total of 116 patients were included,and they were divided into two groups:patients who underwent perioperative reduction treatment(PORT)following LVA surgery(PORT group,51 patients)and patients who underwent no additional perioperative intervention after LVA surgery(control group,65 patients).PORT included compression therapy and remedial exercise.A total of 41 matched pairs were extracted after propensity score matching analysis.The edema reduction effect was compared between the two groups.Results:Patients who underwent PORT had a significantly higher edema reduction than those in the control group(reduction in lower extremity lymphedema index,14.7 vs.6.7;P=0.03).No unfavorable complications related to PORT were observed in our cohort.Conclusion:It would be highly beneficial to combine reduction treatment in the early postoperative period after LVA surgery to maximize treatment outcomes.
文摘Aim:Lymphaticovenular anastomosis(LVA)is the mainstay of surgical treatment of lymphedema now.Indocyanine green(ICG)lymphography is a method for detecting lymphatic pathways and for the clinical evaluation of patients with extremity lymphedema.The essential point of LVA is to find more functional lymphatic vessels.Sometimes,in cases of lymphatic dysfunction,ICG injections into the distal extremities are insufficient.The purpose of this study was to elucidate the effect of multi-injection of ICG lymphography on LVA.Methods:In this study,we injected ICG into the second web of the hands or the first web of the feet.In the multi-injection group,we injected additional ICG in other sites.We observed the presence or absence of a linear pattern at each injection site with a near-infrared camera.Then,we performed LVA and evaluated the circumference change and the operation time.Results:In the multi-injection group,we injected ICG into the upper limb at an average of 2.2 sites(range:1-3 sites)and the lower limb at an average of 3.2 sites(range:1-5 sites).The circumference change of upper limbs in the control group was-3.95%±1.34%and in the multi-injection group was-6.96%±0.88%(P<0.05).The change in circumference of lower limbs was-5.01%±2.2%in the multi-injection group and-2.33%±1.77%in the control group(P=0.003).The mean surgical duration was significantly shortened in the multi-injection group(P<0.05).Conclusion:By injecting ICG into multiple sites of the affected limbs,we could detect more functional lymphatic vessels during LVA,which was helpful for achieving a successful surgical result.
文摘Lymphaticovenular anastomosis(LVA)is a highly effective,minimally invasive surgical treatment for lymphedema.The effect of LVA appears immediately after the creation of lymph-to-venous pathway.However,the long-term outcome of LVA is not always promising when the lymph-to-venous anastomosis has any potential risk of occlusion.The reasons of postoperative LVA occlusions are considered both a technical matter in performing LVA and a strategic matter in preoperative planning.This report focuses on intraoperative techniques of LVA to avoid postoperative occlusions.Depending on the types of undesirable surgical procedures,lymphaticovenular anastomoses are at risk of future occlusions in early,mid-,or late-postoperative course.The authors describe fundamental and essential techniques to perform supermicrosurgical LVA,and the true concept of Isao Koshima’s supermicrosurgery,in which the pith and marrow of the doctrine is not only the way of handling the small vessels or needles,but also the surgeons’skills to feel intima of the vessels and lymphatic flow itself.
基金JSPS KAKENHI Grant Number JP17K17038(to Seki Y).
文摘Lymphaticovenular anastomosis(LVA)is a highly effective,minimally invasive surgical treatment for lymphedema.The clinical effect of LVA begins immediately after the creation of the lymph-to-venous pathway.However,the long-term effect of LVA is not always promised when the lymph-to-venous bypass has any potential risk of occlusion,especially when the disorder has reached the late stage.The reasons of postoperative LVA occlusion are considered both a technical matter in performing LVA and a strategic matter in planning LVA.This article focuses on the effective preoperative LVA planning methodology of“functional LVA”for peripheral lymphedema,in which continuous and strong lymph flow at the anastomosis is created by the muscle pumping power of patients’natural motions at the selected incision point.The current functional LVAs which we have developed are the dynamic LVA method for upper extremity lymphedema and the superior-edge-of-the-knee incision method for lower extremity lymphedema.Because these methods reduce the risk of postoperative LVA occlusion by continuous lymph-to-venous flow at the LVA,functional LVAs keep long-term clinical effect in reduction of lymphedema.
文摘Axillary lymph node dissection-dependent chyle leakage is a rare complication with an incidence of<0.7%.The morbidity could be high,and the management prolonged and not clear.The literature offers us many therapeutical tools,yet there is no consensus about the management of this complication.Usually,the management focuses on reducing the chyle flow in the thoracic duct(central origin),neglecting the possibility of a parallel lymphorrhea from other regional lymphatic vessels(peripheral origin),which causes a prolonged approach with high morbidity.In this paper,we introduce the supermicrosurgery technique as a surgical therapeutic option for chyle leakage.To decrease morbidity and shorten treatment duration,we offer a therapeutic algorithm based on the literature and our experience.
文摘Early surgical intervention for lymphedema can delay,prevent,and even reverse lymphatic degeneration.Vascularized lymph vessel transplant(VLVT)has emerged as an alternative to vascularized lymph node transplant(VLNT)for the treatment of advanced,fluid-predominant lymphedema,providing highly favorable outcomes with reduced donor-site complications.Lymphaticovenular anastomosis(LVA)has traditionally been reserved for early disease.However,technical refinements have improved its results and expanded its efficacy,creating an overlap between the indications for VLVT/VLNT and LVA.This article describes our technical approach to VLVT and LVA and explores the nuances of treatment selection in the light of their shifting indications.
文摘The effectiveness of supermicrosurgical lymphovenous anastomosis(LVA)for lymphedema treatment remains controversial.Currently,no evidence has been summarized.This study aimed to review the published literature on supermicrosurgical LVAs in the treatment of peripheral lymphedema and to analyze the surgical outcomes.Studies from databases(PubMed/MEDLINE,Cochrane Controlled Trial Data,and Embase)were collected to determine the effectiveness of supermicrosugrical LVAs for lymphedema.A systematic review was performed using individual patient data.Fifteen studies,including 578 patients(482 female,72 male,and 24 unknown)with a mean age of 51 years,satisfied the needs of the study requirements.Supermicrosurgical LVAs for peripheral lymphedema have demonstrated substantial improvements in both objective and subjective findings in many patients.Moreover,in the long-term follow-up,the effectiveness of this treatment modality maintained a high efficacy of LVA in lymphedema cases.However,most studies provided low-quality evidence,and the conclusion is still not finalized.
文摘目的探讨淋巴静脉吻合术(lymphaticovenular anastomosis,LVA)治疗乳腺癌相关淋巴水肿(breast cancer-related lymphedema,BCRL)的应用效果及手术技巧。方法自2021年3月,对18例乳腺癌术后继发上肢淋巴水肿的患者行LVA,以重建上肢淋巴系统功能,术后配合压力治疗及淋巴手法引流治疗。定期随访至少2年,测量肢体周径及体积,根据淋巴水肿生活质量评定量表(lymphedema quality of life questionnaire,LYMQOL)评分及总体生活质量评分评估手术疗效。结果18例患者单侧肢体平均完成(8.8±0.9)个淋巴管静脉吻合(6~10个)。术后2年11例患者肢体体积较前下降,有效率为61.1%(11/18),平均肢体体积消减率达(16.5±9.1)%,术后2年LYMQOL评分中外观维度和症状维度较术前改善(P<0.01),总体生活质量评分较术前改善(P<0.01)。结论LVA治疗乳腺癌相关淋巴水肿有创伤小、恢复快的优势,可以有效改善症状,但长期结果仍需要继续观察。
