组织工程与重建外科杂志

组织工程与重建外科杂志 ›› 2022, Vol. 18 ›› Issue (1): 8-.

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薄层血管化腹股沟淋巴结皮瓣移植联合反向淋巴显影在继发性上肢淋巴水肿手术中的应用

  

  • 出版日期:2022-02-01 发布日期:2022-06-22

Application of thin vascularized lymph node transfer combined with reverse mapping in the treatment of secondary upper extremity lymphedema

  • Online:2022-02-01 Published:2022-06-22

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摘要： 目的　探讨薄层血管化腹股沟淋巴结皮瓣移植联合反向淋巴显影在继发性上肢淋巴水肿手术中的应用效果。方法　2019年7月至2020年9月，应用吲哚菁绿、美蓝双染法引导的反向淋巴显影术，制备薄层游离血管化腹股沟淋巴结皮瓣，切取后移植于患侧上肢，治疗乳腺癌术后继发性淋巴水肿患者5例。皮瓣约10 cm×5 cm大小，平均厚度约0.7 cm，切取供区淋巴结约2~3枚，术后随访7~15个月。结果　5例皮瓣存活良好，淋巴结均存活。术后随访显示，患肢臂围均于1.5个月后出现明显缩小，供区无并发症。结论　联合反向淋巴显影技术完成的薄层血管化淋巴结游离皮瓣移植治疗继发性上肢淋巴水肿疗效优良，明显改善患肢臃肿外形。

关键词: 薄层血管化腹股沟淋巴结皮瓣移植, 　淋巴水肿, 　吲哚菁绿, 　反向淋巴显影, 　乳腺癌

Abstract: Objective　To explore the effect of thin vascularized lymph node transfer (VLNT) combined with reverse mapping in the treatment of secondary upper extremity lymphedema. Methods　From July 2019 to September 2020, the free vascularized inguinal lymph node thin-layered flap was prepared by the reverse mapping guided by indocyanine green and methylene blue double staining, which was excised and transplant to the upper limb of the affected side to treat 5 patients with secondary lymphedema after the operation of breast cancer. The flap was about 10 cm×5 cm in size and 0.7 cm in thickness. About 2 to 3 lymph nodes in the donor area were excised. The patients were followed up for 7 to 15 months. Results　All the flaps survived well and all lymph nodes survived. In postoperative follow-up, the circumference of the affected limb was significantly reduced 1.5 months later, and the donor area had no complications. Conclusion　Thin VLNT combined with reverse mapping in the treatment of secondary upper extremity lymphedema has good efficacy and aesthetic effect.

Key words: Thin vascularized lymph node transfer, 　Lymphedema, 　Indocyanine green, 　Reverse mapping, 　Breast cancer