Weiss M, Baumeister R G H, Hahn K
Klinik und Poliklinik für Nuklearmedizin, Ludwig-Maximilians-Universität München, Germany.
Handchir Mikrochir Plast Chir. 2003 Jul;35(4):210-5. doi: 10.1055/s-2003-42136.
Autologous lymph vessel transplantation significantly improves the lymph drainage in patients with primary and secondary lymphedema. The aim of the present study was to prove whether scintigraphic long-term follow-up could demonstrate the function of autologous lymph vessels and the persisting success of this microsurgical technique respectively. In this study, visual and semiquantitative lymphoscintigraphy was used to prove the function of lymphatic vessel grafts in 20 patients comparing a preoperative baseline study with postoperative follow-up investigations once a year for a period of seven years. The reason for microsurgical lymph vessel transplantation was a primary (n = 4) or a secondary (n = 16) lymphedema. In 12 cases the transplantation site was at the upper extremity, in eight cases at the lower limb. In 17/20 patients lymphatic function significantly improved after autologous lymph vessel transplantation compared to the preoperative findings, as verified by visual improvement of lymph drainage and decrease of a numeric transport index. In 5/20 cases the vessel graft could be visualized directly. In these patients with scintigraphic visualization of the vessel graft, the transport index decreased to a significantly greater extent compared to the preoperative baseline study. 3/20 patients did not benefit from microsurgical treatment. Lymphoscintigraphy has shown to be an easy, reliable and readily available technique to assess lymphatic function on the long run. Scintigraphic visualization of the vessel graft showed a significantly better postoperative outcome than those without. The scintigraphic visualization of the vessel graft therefore seems to indicate a favourable prognosis regarding lymph drainage.
自体淋巴管移植可显著改善原发性和继发性淋巴水肿患者的淋巴引流。本研究的目的是证明放射性核素长期随访是否能够分别显示自体淋巴管的功能以及这种显微外科技术的持续成功。在本研究中，采用视觉和半定量淋巴闪烁显像术，对20例患者的淋巴管移植功能进行评估，将术前基线研究与术后每年一次、为期七年的随访检查进行比较。显微外科淋巴管移植的原因是原发性淋巴水肿（n = 4）或继发性淋巴水肿（n = 16）。12例移植部位在上肢，8例在下肢。与术前结果相比，17/20的患者在自体淋巴管移植后淋巴功能显著改善，这通过淋巴引流的视觉改善和数值转运指数的降低得到证实。在5/20的病例中，可以直接观察到移植的血管。在这些通过闪烁显像观察到移植血管的患者中，与术前基线研究相比，转运指数下降的幅度明显更大。3/20的患者未从显微外科治疗中获益。淋巴闪烁显像术已被证明是一种长期评估淋巴功能的简单、可靠且易于获得的技术。移植血管的闪烁显像显示术后结果明显优于未观察到移植血管的患者。因此，移植血管的闪烁显像似乎表明淋巴引流预后良好。
