Predictive Lymphatic Mapping A Method for Mapping Lymphatic Channels in Patients With Advanced Unilateral Lymphedema Using Indocyanine Green Lymphography
Predictive Lymphatic Mapping A Method for Mapping Lymphatic Channels in Patients With Advanced Unilateral Lymphedema Using Indocyanine Green Lymphography
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DOI：
10.1097/sap.0b013e31826a18b1
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发表时间：
2014-06-01
影响因子：
1.5
通讯作者：
Koshima, Isao
中科院分区：
文献类型：
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作者：
Mihara, Makoto;Seki, Yukio;Koshima, Isao
在严重淋巴水肿中，吲哚菁绿淋巴造影不能用于在淋巴小静脉吻合术 (LVA) 之前绘制淋巴通道图，因为在严重受影响的腿部中无法检测到线性淋巴管。在这里，我们描述了一种新方法，我们称之为预测性淋巴图谱，用于预测单侧淋巴水肿吻合的淋巴管位置，从而提高手术准确性和效率。该方法包括标记解剖标志并用固定线连接选定的标志。然后测量从这些固定线到未受影响的腿中通过吲哚菁绿淋巴造影绘制的淋巴通道的距离，根据腿之间的周长差异按比例放大，并转移到受影响的腿。迄今为止，我们已使用该方法治疗5例单侧或不对称下肢淋巴水肿。在任何情况下，我们都能够在 2 厘米的切口内找到适合 LVA 的淋巴通道。这些结果表明，预测性淋巴图谱对于外科医生在局麻下进行 LVA 来说是一个有用的附加工具，这将有助于提高切口的准确性和手术效率。
In severe lymphedema, indocyanine green lymphography cannot be used to map lymphatic channels before lymphaticovenular anastomosis (LVA) because linear lymphatics cannot be detected in a severely affected leg. Here, we describe a new method, which we refer to as predictive lymphatic mapping, to predict the location of lymphatics for anastomosis in unilateral lymphedema, thereby improving surgical accuracy and efficiency. The approach consists of marking anatomical landmarks and joining selected landmarks with fixed lines. The distance from these fixed lines to lymphatic channels mapped by indocyanine green lymphography in the unaffected leg is then measured, scaled up based on the difference in circumference between the legs, and transposed to the affected leg. To date, we have used this method in 5 cases of unilateral or asymmetric lymphedema of the lower extremities. In no cases have we failed to find a lymphatic channel suitable for LVAwithin a 2-cm incision. These results suggest that predictive lymphatic mapping is a useful additional tool for surgeons performing LVA under local anesthesia, which will help to improve the accuracy of incisions and the efficiency of surgery.