组织工程与重建外科杂志 ›› 2023, Vol. 19 ›› Issue (5): 459-.

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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

  

  • 出版日期:2023-10-09 发布日期:2023-11-01

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

  • Online:2023-10-09 Published:2023-11-01

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(Lym
phaticovenular 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。

关键词:

Abstract:

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.

Key words:

point injection