Factors Associated with Lymphosclerosis: An Analysis on 962 Lymphatic Vessels
Factors Associated with Lymphosclerosis: An Analysis on 962 Lymphatic Vessels
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淋巴硬化相关因素：962条淋巴管分析
DOI：
10.1097/prs.0000000000003690
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发表时间：
2017
影响因子：
3.6
通讯作者：
I. Koshima
中科院分区：
文献类型：
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作者：
Takumi Yamamoto;N. Yamamoto;H. Yoshimatsu;M. Narushima;I. Koshima
背景资料：淋巴静脉吻合术是治疗压迫难治性下肢水肿的有效方法，但其疗效在很大程度上取决于淋巴硬化的严重程度。为了最大限度地提高肠系膜静脉吻合术的疗效，阐明与严重淋巴硬化相关的因素是很重要的。研究方法：对134例接受术前吲哚菁绿色淋巴造影和血管吻合术的下肢水肿患者的病历进行了回顾，以获得临床人口统计学、吲哚菁绿色淋巴造影结果和术中结果的数据。根据术中发现的淋巴管，将淋巴硬化的严重程度分为s 0、s1、s2和s3。重度淋巴硬化定义为淋巴管伴s3硬化。Logistic回归分析用于确定与严重淋巴硬化症相关的独立因素。结果：共分析了962条淋巴管，其中97条（10.1%）观察到严重的淋巴硬化。多因素分析显示，与严重淋巴硬化症相关的独立因素是较高的体重指数（OR，1.803; 95% CI，1.041 - 3.123; p = 0.035），大腿/足部切口部位与腹股沟切口部位相比（OR，2.355/4.471; 95%CI，1.201至4.617/2.135至9.362; p = 0.013/p < 0.001），吲哚菁绿色淋巴造影的S区/D区与L区相比（OR，83.134/1441.126; 95%CI，11.296至611.843/146.782至14149.195; p < 0.001/p < 0.001）。在放射治疗的阳性史中观察到反向关联（OR，0.461; 95%CI，0.269至0.788; p = 0.005）。结论：阐明了与严重淋巴硬化相关的独立因素。吲哚菁绿色淋巴造影模式与严重淋巴硬化症的相关性最强。静脉吻合术应避开吲哚菁绿色淋巴造影的D区。临床问题/证据等级：风险，III。
Background: Lymphaticovenular anastomosis is a useful treatment option for compression-refractory lower extremity lymphedema, but its efficacy depends largely on the severity of lymphosclerosis. To maximize lymphaticovenular anastomosis efficacy, it is important to elucidate factors associated with severe lymphosclerosis. Methods: Medical charts of 134 lower extremity lymphedema patients who underwent preoperative indocyanine green lymphography and lymphaticovenular anastomosis were reviewed to obtain data of clinical demographics, indocyanine green lymphography findings, and intraoperative findings. Based on intraoperative findings of lymphatic vessels, severity of lymphosclerosis was classified into s0, s1, s2, and s3. Severe lymphosclerosis was defined as lymphatic vessels with s3 sclerosis. Logistic regression analysis was used to identify independent factors associated with severe lymphosclerosis. Results: In total, 962 lymphatic vessels were analyzed, among which severe lymphosclerosis was observed in 97 (10.1 percent). Multivariate analysis revealed that independent factors associated with severe lymphosclerosis were higher body mass index (OR, 1.803; 95 percent CI, 1.041 to 3.123; p = 0.035), incision site in the thigh/foot compared with in the groin (OR, 2.355/4.471; 95 percent CI, 1.201 to 4.617/2.135 to 9.362; p = 0.013/p < 0.001), and S-region/D-region on indocyanine green lymphography compared with L-region (OR, 83.134/1441.126; 95 percent CI, 11.296 to 611.843/146.782 to 14149.195; p < 0.001/p < 0.001). Inverse associations were observed in positive history of radiation therapy (OR, 0.461; 95 percent CI, 0.269 to 0.788; p = 0.005). Conclusions: Independent factors associated with severe lymphosclerosis were clarified. Indocyanine green lymphography pattern had the strongest association with severe lymphosclerosis. D-region on indocyanine green lymphography should be avoided for lymphaticovenular anastomosis. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
吲哚菁绿淋巴管造影结果与采集条件的比较
DOI：
--
发表时间：
2014
期刊：
影响因子：
--
作者：
大林樹真;関保二;長江秀樹;眞鍋周太郎;大山慧;Kevin C. Pringle;小池淳樹;高木正之;北川博昭;Hisako Hara
通讯作者：
Hisako Hara