de Rezende Laura Ferreira, Pedras Felipe Villela, Ramos Celso Dario, Gurgel Maria Salete Costa
Department of Obstetrics and Gynecology, Universidade Estadual de Campinas UNICAMP Medical School, São Paulo, Brazil.
Tumori. 2011 May-Jun;97(3):309-15. doi: 10.1177/030089161109700309.
To evaluate postoperative lymphatic compensation in the upper limb after mastectomy with axillary dissection.
Twenty-three patients who underwent lymphoscintigraphy before and 60 days after surgery were enrolled from September 2006 to June 2007, in Campinas, Brazil. Protocol examination consisted in static imaging of each upper limb in semi-flexion and thoracic imaging after 10 min and 1 and 2 hr after subcutaneous injection of 1 mCi (37 MBq) of 99mTc dextran into the dorsum of the hand. A comparative analysis was made of hepatic uptake of the radiopharmaceutical, velocity of axillary lymph node visualization (I, visible at 10 min; II, at 1 hr; III, at 2 hr; IV, not visible) and degree (intensity) of uptake (a, marked; b, moderate; c, mild; d, absent) before and 60 days after surgery.
In the preoperative period, 3 (13%) patients were considered to have an optimal pattern (Ia) and 2 (9%) showed total involvement (IVd). Compared to velocity in the postoperative period, 9 (39%) patients showed no difference, 5 (22%) improved, 9 (39%) became worse, and one was considerably worse. Regarding the degree, 10 (43%) patients showed no difference, 9 (39%) became worse, and 4 (17%) improved. Regarding classification, 2 (9%) patients had an optimal lymphatic pattern (Ia) and 3 (13%) had total involvement (IVd). No patient presented decreased hepatic uptake after surgical treatment.
The study found relevant changes in preoperative and postoperative lymphoscintigraphy, demonstrating the existence of functional differences in the lymphatic system of the upper limb. Alterations in lymphatic drainage pattern may already be perceived 60 days postoperatively, as can signs of lymphovenous anastomoses.
评估乳房切除加腋窝淋巴结清扫术后上肢的术后淋巴代偿情况。
2006年9月至2007年6月期间，在巴西坎皮纳斯招募了23例在手术前和术后60天接受淋巴闪烁显像的患者。检查方案包括在将1毫居里（37兆贝可）的99mTc葡聚糖皮下注射到手背后10分钟、1小时和2小时，对每个半屈曲上肢进行静态成像以及胸部成像。对手术前和术后60天放射性药物的肝脏摄取、腋窝淋巴结显影速度（I，10分钟可见；II，1小时可见；III，2小时可见；IV，不可见）和摄取程度（强度）（a，明显；b，中度；c，轻度；d，无）进行了对比分析。
在术前阶段，3例（13%）患者被认为具有最佳模式（Ia），2例（9%）显示完全受累（IVd）。与术后阶段的速度相比，9例（39%）患者无差异，5例（22%）有所改善，9例（39%）变差，1例明显变差。关于程度，10例（43%）患者无差异，9例（39%）变差，4例（17%）有所改善。关于分类，2例（9%）患者具有最佳淋巴模式（Ia），3例（13%）完全受累（IVd）。手术治疗后没有患者出现肝脏摄取减少的情况。
该研究发现术前和术后淋巴闪烁显像有相关变化，表明上肢淋巴系统存在功能差异。术后60天可能已察觉到淋巴引流模式的改变以及淋巴静脉吻合的迹象。
