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In September 2020, an elderly patient with cognitive impairment(CI) was admitted in Deparment of Microsurgery, Hangzhou Qiushi Hospital. The patient was in bed and could not answer correctly before surgery. The preoperative Minimum Mental State Examination(MMSE) score was 3(3/30) and the Montreal Cognitive Assessment (MoCA) score was 2(2/30). After completion of preoperative examinations, a 3D microscope combined with fluorescence tracing technique was used to perform deep cervical lymphatic-venous anastomosis at the bilateral cervical Va lymph nodes part: two anastomosis methods were performed, one was end to side anastomosis and the other was end to end anastomosis. The diameters of all anastomotic dilated lymphatic vessels were less than 0.2 mm, the diameters of end-to-side, end to end anastomotic veins were 0.6 mm and 0.2 mm. Short-term postoperative anti-inflammatory treatment was given and a long-term functional rehabilitation training was performed. There were no postoperative complications and the incision healed well. The MMSE scores were 8, 12, 14, 18 point, and the MoCA scores were 8, 9, 11, 13 point. At 3, 30, 90, 180 days after surgery, respectively. Basic cognitive function was restored at 9 months after surgery.
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Objective: To review the clinical progress of microsurgical management for lymphedema. Methods: The literature on microsurgical treatment for lymphedema at home and abroad in recent years was reviewed and analyzed. Results: At present, conservative treatment is the main treatment for lymphedema, which has limited effectiveness only for early stages of lymphedema; and it is not curative and demands patient compliance. In contrast, microsurgical approaches can solve the problems in the prevention or management of lymphedema and showed promising results, such as lymphatic-venous anastomosis (LVA), vascularized lymph node transfer (VLNT), and other lymphatic reconstructions. Conclusion: Microsurgical approaches like LVA and VLNT have been broadly used in recent years, the effectiveness and safety have been proved. But the evidence of long-term randomized controlled studies is still required to establish standard treatment practices.
RESUMO
Objective To explore the analgesic effect of ropivacaine and flurbiprofen for patients with secondary upper extremity lymphedema after lymphatic venous anastomosis . Methods A total of 45 cases of lymphatic venous anastomosis under general anesthesia between October 2014 and March 2016 were randomly allocated to 3 groups: ropivacaine group ( group R ) , flurbiprofen preprocessing group (group F1), and flurbiprofen postprocessing group (group F2), with 15 cases in each group.Local infiltration anesthesia was made with 0.2% ropivacaine 10 ml at the incision before the end of operation in the group R .The flurbiprofen 100 mg was intravenously injected at 5 minutes before the induction of anaesthesia in the group F 1 and 5 minutes before the end of operation in the group F 2 .The visual analogue scale ( VAS) scores and the number of patients using analgesics after operation at 1, 2, 6, 12, 24 and 48 h were recorded. Results The rest pain and movement pain VAS scores at postoperative 2 h were lower in the group R than those in the group F1 and F2[rest pain:(3.4 ±0.7) points vs.(4.2 ±0.9) points vs.(4.1 ±1.0) points, F=3.741, P=0.032;movement pain:(3.7 ±0.6) points vs.(4.6 ±0.9) points vs.(4.4 ±1.0) points, F=4.305, P=0.020]. The rest pain VAS scores at postoperative 6 h were lower in the group R than those in the group F 1 and F2 [(2.7 ±0.5) points vs. (3.4 ±0.5) points vs.(3.1 ±0.6) points, F=5.783, P=0.006].The number of patients requiring analgetics was lower in the group R than that in the group F1 and F2 at postoperative 2 h (1 case vs.7 cases vs.5 cases,χ2 =6.058, P=0.048). Conclusion Local anesthesia with ropivacaine in patients after lymphatic venous anastomosis can achieve good postoperative analgesia .