多点注射吲哚菁绿红外显影在下肢淋巴管-静脉吻合术中的应用  

Application of multipoint injection indocyanine green lymphography in lymphaticovenular anastomosis of lower limbs

作　　者：周煦川 刘宾 王文飞 秦傲霜 王奕迪 马戈甲 ZHOU Xuchuan;LIU Bin;WANG Wenfei;QIN Aoshuang;WANG Yidi;MA Gejia(Department of Burn,Plastic and Cosmetic Surgery,Xi’an Central Hospital,Xi’an Jiaotong University,Xi’an 710003,China.)

机构地区：[1]西安交通大学附属西安市中心医院烧伤整形美容外科,陕西省西安市710003

出　　处：《组织工程与重建外科》2023年第5期459-463,共5页Journal of Tissue Engineering and Reconstructive Surgery

基　　金：西安市创新能力强基计划-医学研究项目(编号:22YXYJ0077)。

摘　　要：目的探索术前多点注射吲哚菁绿(Indocyanine green,ICG)红外显影在下肢淋巴管-静脉吻合术(Lymphaticovenular anastomosis,LVA)中的应用,分析改良显影方法的应用价值。方法选取2020年12月至2022年6月就诊的57例下肢淋巴水肿患者作为研究对象,分为单点注射组(n=25)和多点注射组(n=32)。单点注射组在第一趾蹼注射ICG;多点注射组在第一趾蹼、内外踝和膝关节内外侧共5个点注射ICG。两组患者均通过红外显影观察并标记线性淋巴管,行LVA治疗,比较术中吻合淋巴管数目和手术时间差异。术后随访6个月,采用下肢淋巴水肿指数(Lower extremity lymphedema index,LELI)作为预后指标,观察两组患者术后淋巴水肿症状缓解情况。结果多点注射组吻合淋巴管数目高于单点注射组,手术时间少于单点注射组,差异有统计学意义(P<0.05);LVA术后6个月,单点注射组和多点注射组的LELI均低于术前(P<0.05)。两组患者术后患肢周径均缩小,多点注射组LELI减少程度高于单点注射组,差异有统计学意义(P<0.05)。结论术前多点注射吲哚菁绿红外显影可在术前发现更多的线性淋巴管,缩短术中寻找淋巴管的时间,具有较高的临床应用价值。Objective To explore the application of multipoint injection indocyanine green(ICG)lymphography in lymphaticovenular anastomosis(LVA)of lower limbs and analyze the advantages of the improved lymphography.Methods From December 2020 to June 2022,57 patients with lower limb lymphedema were selected as the study subjects and were divided into the single injection group(n=25)and the multi-injection group(n=32).In the single injection group,ICG was injected into the first toe web.In the multi-point injection group,ICG was injected preoperatively at the first web,medial malleolus,lateral malleolus,medial knee and lateral knee.The linear pattern was observed by ICG lymphography and LVA was performed in both groups.The number of lymphatic vessels anastomosed and the time of surgery were compared.Lower extremity lymphedema index(LELI)was used as the prognostic index,the symptom relief of lymphedema half a year after LVA was evaluated in both groups.Results The number of anastomotic lymphatic vessels in the multi-injection group was higher than that in the single injection group,and the surgery time was lower than that in the single injection group(P<0.05).The LELI of the multi-injection group and the single injection group half a year after LVA were lower than that before operation(P<0.05).The circumference of the affected limb was reduced in both groups after operation,the reduction of LELI in the multi-point injection group was higher than that in the single injection group(P<0.05).Conclusion Multipoint injection indocyanine green lymphography can find more pattern before operation and shorten the time of looking for lymphatic vessels,which has high clinical application value.

关 键 词：下肢淋巴水肿 淋巴管-静脉吻合术 吲哚菁绿 淋巴管显影 多点注射 

分 类 号：R622[医药卫生—整形外科]