lymph node venous anastomosis

Lymph node venous anastomosis (LVS) is a process in which the lymph nodes associated with the lymphatic vessels are cut into two lobes, and the lymph node section is anastomosed to the end or end of the adjacent vein. It is commonly used to anastomize the axillary lymph nodes in the cephalic vein, the axillary lymph nodes are anastomosed to the femoral vein, or the inguinal lymph nodes are anastomosed to the saphenous vein. Treatment of diseases: lymphedema of limbs and lymphedema Indication 1. Limb lymphangiography of the limbs has a typical lymphatic deposit, often with pelvic lymphatic obstruction, but the inguinal lymph nodes are not invaded. More common in pelvic malignant tumors, can be performed in the inguinal lymph node saphenous vein anastomosis. 2. The lower limbs of primary proliferative lymphedema patients are mostly 6 to 8 years old, the whole lower limbs are swollen, and many varicose lymphatic vessels can be seen in the angiography. The valve is insufficiency, the contrast agent is refluxed, and remains in the foot for several days. LVS can be performed in the groin. 3. Primary dysplastic lymphedema edema is progressive and painful. The angiography only showed a small lymphatic vessel, and there was lymphatic reflux. After 24 hours, the contrast agent remained in the groin. Contraindications Patients with severe saphenous vein lesions, such as iliac vein embolization and acute vascular embolization, should not be performed. Preoperative preparation 1. In addition to understanding the heart, lung, liver, kidney function and coagulation function, the systemic response to patients with chronic erysipelas infection is very light. If the affected limb has flushing and the local temperature increases, it must first be treated with antibiotics. Surgery can be performed until there is no local inflammation. 2. Accurately record the swelling of the limbs There are two ways to record: 1 measure the circumference of the limb. Specific figures for the segments of the thigh, knee, calf and ankle can be recorded separately. However, the bone mark must be used to determine the inspection site each time to avoid errors. 2 Drainage method to measure the swelling of the limbs, that is, the affected limbs are immersed in a water tank or a large and small bottle, and the amount of water discharged is observed, and the bilateral limbs are compared at the same time. 3. Before the operation, let the patient rest in bed, raise the affected limb, and if necessary, apply diuretic drugs, elastic bandages, and electric blankets to wrap the limbs to minimize the swelling of the limbs for the operation. 4. Because the skin of the rubberized patient is severely keratinized, the skin can be disinfected 1 to 3 days in advance and disinfected with a stimulating 0.1% benzalkonium bromide solution. 1d before surgery, shave and clean the skin, but do not damage the skin. Because of local low resistance, it is easy to induce infection. Eczema is particularly prone to occur in the contact between the toe and the swollen skin. It should be thoroughly treated before surgery. 5. Perform lymphatic biopsy to understand lymphatic vessels and lymph nodes to help select the appropriate lymphatic anastomosis method. If the lymph nodes are widely affected, lymph node venous anastomosis should not be selected, and lymphatic venous anastomosis should be performed. However, because the contrast agent stays in the limb for a long time, the irritation is large, the reaction is also large, and the symptoms of lymphatic inflammation and the degree of obstruction are aggravated, which is unfavorable for surgery, so the angiography is performed only when the diagnosis or judgment is suspicious. After the angiography, the surgery needs to be performed after the stimulation reaction is eliminated. 6. Apply antibiotics to prevent infection. For frail and elderly patients, a small amount of fresh whole blood can be prepared, or some albumin or gamma globulin can be added to help improve the body's resistance and prevent infection. 7. Due to the long operation time, it is best to indwell the catheter during the operation. Surgical procedure Incision The surgical site is often performed in the armpits, groin, and axilla. Take a longitudinal incision. 2. Looking for lymph nodes In order to facilitate the accurate search for lymph nodes, lymphatic staining can be performed in the same manner as lymphatic vein anastomosis. The skin was cut on the designed incision line to reveal subcutaneous adipose tissue, and lymph nodes were found in the adipose tissue along a plurality of lymphatic vessels stained blue under a 8-12 microscope. Care should be taken to remove the lymph nodes and the lymphatic vessels and blood vessels that enter the lymph nodes. When looking for lymph nodes, the large veins of the desired anastomosis are simultaneously revealed. 3. Lymph node vein anastomosis The lymph nodes to be found are in the distal 1/3 plane, perpendicular to the long axis, and a large amount of blue-stained lymph is discharged from the section. The adjacent veins are then used to block the venous blood flow at the upper and lower ends, and a longitudinal incision is made on the vein wall to coincide with the lymph node section. Generally, a suture with a needle of 11-0 single nylon thread is used, and only the capsule of the lymph node is sutured during anastomosis. 4. Suture incision Insulate the incision with isotonic saline, completely stop bleeding, and suture the incision in layers. The affected limb is bandaged with an elastic bandage.