Donor-site lymphatic function after microvascular lymph node transfer should be followed using indocyanine green lymphography.
Donor-site lymphatic function after microvascular lymph node transfer should be followed using indocyanine green lymphography.
复制标题
微血管淋巴结转移后的供体部位淋巴功能应使用吲哚菁绿淋巴造影进行跟踪。
DOI：
10.1097/prs.0b013e31827c7194
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发表时间：
2013
影响因子：
3.6
通讯作者：
I. Koshima
中科院分区：
文献类型：
--
作者：
Shuchi Azuma;Takumi Yamamoto;I. Koshima
Viitanen 等人的“淋巴结转移”。他们的工作是革命性的，因为他们试图使用淋巴闪烁显像术客观地评估淋巴转移后供体腹股沟部位的淋巴管功能。1 正如他们所指出的，淋巴水肿症状可能在手术或创伤后出现，因此没有人可以否认治疗上肢淋巴水肿可能导致下肢淋巴水肿的可能性。如果是这样，我们有责任在患者接受手术之前向他们解释这一事实。Viitanen 等人等人对 10 名患者应用淋巴闪烁扫描来评估供体部位的肢体，他们报告说，10 名患者中有 6 名术后发现了供体部位的淋巴流量发生了微小变化，但没有一位患者报告了相同的概念，并使用吲哚青绿淋巴造影（而不是淋巴闪烁扫描）将其命名为亚临床淋巴水肿 2。吲哚菁绿淋巴造影的真皮回流模式可以检测到肢体淋巴水肿，在我们的文章中，我们发现淋巴回流异常从飞溅模式到星尘模式，最后到弥漫模式2-4我们得出结论，飞溅模式是下肢淋巴水肿患者无症状肢体的吲哚青绿淋巴造影最早发现的，这就是为什么我们在术后遇到飞溅模式时应该谨慎跟踪。通过我们的系列研究，我们发现上肢和下肢的淋巴水肿表现出相同的皮肤回流模式 4 吲哚菁绿淋巴造影和淋巴闪烁造影最重要的区别是敏感性 5 我们比较了吲哚菁绿淋巴造影和淋巴闪烁造影对淋巴液流动功能障碍的早期检测，结果发现吲哚菁绿淋巴造影的敏感性为 100%，而淋巴闪烁造影的敏感性为 62%。在讨论供体部位发病率时，我们应该使用吲哚菁绿而不是淋巴显像术，可以防止进一步进展，因此我们相信，为此目的，吲哚菁绿淋巴显像术优于淋巴显像术。在治疗淋巴水肿时，我们认为是否存在供体部位发病率很重要，因此我们不仅应该对患者进行更长时间的随访，而且应该使用安全、简单、灵敏且廉价的测试来尽早发现病情，以防万一。没有淋巴功能障碍的迹象，因此，我们建议使用吲哚菁绿代替淋巴闪烁显像来诊断淋巴水肿。但是，本文必须被视为淋巴水肿领域最重要的文章之一，因为它是第一篇尝试关注有前途的技术的不良结果的文章。
Lymph Node Transfer” by Viitanen et al. Their work is revolutionary in that they attempted to evaluate objectively the donor groin site lymphatic vessel function after lymphatic transfer using lymphoscintigraphy. 1 As they have pointed out, symptoms of lymphedema could develop following surgery or trauma, and therefore nobody can deny the possibility that lower limb lymphedema could develop as a result of treating upper limb lymphedema. If this is so, it is our duty to explain this fact to patients before they undergo surgery. Viitanen et al. applied lymphoscintigraphy to 10 patients to evaluate the donor-site limbs. In their article, they reported that minor changes in lymphatic flow in the donor sites were revealed in six of 10 patients postoperatively but that none of the patients reported any symptoms in their lower extremities. We already reported the same concept and named it a subclinical lymphedema using indocyanine green lymphography, not lymphoscintigraphy. 2 We found that even asymptomatic limbs with lower extremity lymphedema could be detected by the dermal backflow pattern of indocyanine green lymphography. In our article, we showed that the lymphatic flow abnormality proceeds from a splash pattern to a stardust pattern and finally to a diffuse pattern. 2–4 We concluded that the splash pattern is the earliest finding on indocyanine green lymphography of asymptomatic limbs of lower extremity lymphedema patients. That is why we should follow patients cautiously once we encounter the splash pattern in postoperative limbs. Through our series, we found that lymphedema of upper limbs and that of lower limbs show the same dermal backflow pattern. 4 The most important difference between indocyanine green lymphography and lymphoscintigraphy is sensitivity. 5 We compared indocyanine green lymphography and lymphoscintigraphy for early detection of lymph flow dysfunction, and reported that the sensitivity of indocyanine green lymphography is 100 percent compared with 62 percent for lymphoscintigraphy. This is the strongest reason we should use indocyanine green over lymphoscintigraphy when discussing donor-site morbidity. Early detection of lymphedema could prevent further progression and therefore we are convinced that, for this purpose, indocyanine green lymphography is superior to lymphoscintigraphy.In treating lymphedema, we believe it is important whether there is donor-site morbidity or not and thus we should not only follow patients for longer periods but also use safe, easy, sensitive, and inexpensive tests to detect the condition as early as possible in case there are no signs of lymphatic dysfunction. Thus, we would recommend using indocyanine green instead of lymphoscintigraphy for diagnosis of lymphedema. However, this article must be considered as one of the most important articles in the field of lymphedema because it is the first article to attempt to focus on undesirable results of a promising technique.