血管化淋巴管皮瓣治疗继发性淋巴水肿的进展

Progress of vascularised lymphatic flap in the treatment of secondary lymphedema

继发性淋巴水肿是一种慢性进行性淋巴系统紊乱的疾病,主要的病因是肿瘤术后和(或)放射治疗,其次是严重软组织创伤和慢性炎症过程。随着显微外科技术的不断发展,淋巴水肿的治疗方案也随之涌现。目前淋巴水肿的治疗方案主要集中于淋巴管与淋巴管吻合(LLA)、淋巴管与静脉吻合(LVA)、血管化淋巴结皮瓣移植(VLNT)、血管化淋巴管皮瓣的移植(VLVT),显微外科治疗淋巴水肿均以重建生理性淋巴循环为主。LLA和LVA需要较高的显微技术;VLNT存在着供区医源性淋巴水肿的风险,并且对受区外观有一定影响;VLVT较好地规避上述治疗方案的不足,并且具有确切的临床疗效,供区可以直接缝合。本文就VLVT的发展、治疗机理、临床疗效、手术技术要领和技巧进行综述,希望能为临床治疗淋巴水肿提供更多、更新的治疗理念。

Secondary lymphedema is a chronic progressive disorder of lymphatic system caused by tumour surgery and/or radiotherapy.With the development of microsurgical techniques,the surgical procedures currently applied in the treatment of lymphedema mainly focuses on lymphatic-lymphatic anastomosis(LLA),lymphatic venous anastomosis(LVA),vascularised lymph node transfer(VLNT)and vascularized lymph vessel transfer(VLVT).The goal of microsurgical treatment of lymphedema is to reconstruct the physiological lymphatic circulation.Both of LLA and LVA require higher microsurgical skills.VLNT has a risk of iatrogenic lymphedema in the donor site and has impacts on the appearance of the recipient site,while the VLVT can better avoid the shortcomings of the treatment options mentioned above with a definite clinical effect.The donor site can be directly anastomosed.This article provides detailed reviews and updated concepts in treatment of lymphedema with VLVT in terms of development,therapeutic mechanism,clinical efficacy,surgical techniques and skills of the vascularised lymphatic flap.