A Novel Approach to Subcutaneous Collecting Lymph Ducts Using a Small Diameter Wire in Animal Experiments and Clinical Trials
A Novel Approach to Subcutaneous Collecting Lymph Ducts Using a Small Diameter Wire in Animal Experiments and Clinical Trials
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在动物实验和临床试验中使用小直径导线皮下收集淋巴管的新方法
DOI：
10.1089/lrb.2019.0047
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Taro Mikami
中科院分区：
文献类型：
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作者：
Yuichiro Yabuki ;Jiro Maegawa ;Naohiko Shibukawa ;Shintaro Kagimoto ;Shinya Kitayama ;Shinobu Matsubara ;Taro Mikami
背景：在进行显微外科手术时，包括慢性肢体水肿的下肢静脉吻合术（LVA），使用吲哚菁绿色的近红外荧光淋巴管造影术（NIR）识别皮下集合淋巴管是一种常见的手术。然而，由于最小可观察深度等限制，该程序只能识别少数淋巴管。因此，我们研制了一种直径较小的“淋巴管导丝”（LW），它可以直接插入肢体的淋巴集合管，从而实现准确的识别和定位。方法和结果：首先，在6只猪的后肢上使用LW，识别出36条猪的淋巴集合管，其外径为0.3- 0.7mm（平均0.41 ± 0.11mm）。我们可以在其中30个管道中创建侧开口后插入LW。我们在手术过程中没有遇到任何困难。在病理检查中，未发现瓣膜功能障碍和穿孔等不良事件。根据结果，LW的临床评价进行了两名患者下肢水肿，LW帮助我们确定在皮下层的淋巴管，即使在近红外线已被证明invalid.Conclusion的网站：根据我们的研究结果，我们建议使用新开发的LW识别淋巴管的程序是一个有用的技术，可以利用之前进行LVA水肿。然而，需要进一步的临床研究来开发这种设备和技术，以便将来更广泛地应用于临床。
Background:While performing microsurgery, including lymphaticovenous anastomosis (LVA) for chronic limb lymphedema, it is a common procedure to identify the subcutaneous collecting lymph ducts with near-infrared fluorescence lymphangiography (NIR) using indocyanine green. However, due to limitations such as minimum observable depth, only a few lymphatic ducts can be identified with this procedure. Hence, we developed a new smaller-diameter “lymphatic wire” (LW) that could be inserted directly into lymphatic collecting ducts of the limbs, enabling accurate identification and localization.Methods and Results:First, used the LW on the hind limbs of 6 swine, and 36 porcine lymphatic collecting ducts were identified, the outer diameter of which varied from 0.3–0.7 mm (mean 0.41 ± 0.11 mm). We could insert the LW after creating a side opening in 30 of these ducts. We encountered no difficulties during the procedure. In the pathological examination, adverse events such as valve dysfunction and perforation were not identified. Based on the results, a clinical evaluation of the LW was performed in two patients with lower extremity lymphedema, and the LW helped us identify lymphatic ducts in the subcutaneous layer, even at the sites where the NIR had proved ineffective.Conclusion:Based on our results, we suggest that the procedure for identifying lymphatic vessels using the newly developed LW is a useful technique that can be utilized before performing a LVA for lymphedema. However, further clinical study is required to develop this device and technique, for wider clinical application in the future.