Ayestaray Benoit, Bekara Farid
Department of Plastic and Reconstructive Surgery, Sud Francilien Hospital, University Paris Sud XI, 116, Bd Jean Jaurès, 91000, Evry, France.
Microsurgery. 2015 Jul;35(5):407-10. doi: 10.1002/micr.22368. Epub 2015 Jan 6.
Microscope-integrated lymphangiography is a useful method in the field of lymphatic supermicrosurgery. Fluorescence based on indocyanine green (ICG) is the most commonly used. Fluorescein sodium is a fluorescent tracer used for retinal and neurosurgical angiography but not yet for lymphatic supermicrosurgery. In this report, we present a case in which the fluorescein sodium fluorescence microscope-integrated lymphangiography was used for assessment of lymphatic drainage pathway and patency in a patient treated for secondary lymphedema by lymphaticovenular anastomoses. Fluorescein sodium fluorescence microscope-integrated lymphangiography was evaluated in a 67-year-old female presented for a Campisi clinical stage IV lymphedema of the upper limb. Transcutaneous guidance and vascular fluorescence were assessed. A comparison with ICG fluorescence was made intraoperatively. Two lymphaticovenular anastomoses were performed and their patency were checked by lymphangiography. Transcutaneous signal was found higher with fluorescein sodium fluorescence. Intraluminal visualization was possible with fluorescein sodium coloration during lymphaticovenular anastomoses. No adverse reaction occurred. The circumferential differential reduction rate of affected limb was 8.1% 3 months after lymphaticovenular anastomoses. The use of fluorescence microscope-integrated lymphangiography with fluorescein sodium may be superior to ICG fluorescence in assistance of lymphaticovenular anastomoses.
显微镜集成淋巴管造影术是淋巴超显微外科领域一种有用的方法。基于吲哚菁绿（ICG）的荧光是最常用的。荧光素钠是一种用于视网膜和神经外科血管造影的荧光示踪剂，但尚未用于淋巴超显微外科。在本报告中，我们介绍了一例使用荧光素钠荧光显微镜集成淋巴管造影术评估一名接受淋巴管静脉吻合术治疗继发性淋巴水肿患者的淋巴引流途径和通畅情况的病例。对一名因坎皮西临床IV期上肢淋巴水肿就诊的67岁女性进行了荧光素钠荧光显微镜集成淋巴管造影术评估。评估了经皮引导和血管荧光。术中与ICG荧光进行了比较。进行了两次淋巴管静脉吻合术，并通过淋巴管造影检查其通畅情况。发现荧光素钠荧光的经皮信号更高。在淋巴管静脉吻合术中，荧光素钠染色可实现腔内可视化。未发生不良反应。淋巴管静脉吻合术后3个月，患侧肢体的周向差异缩小率为8.1%。在辅助淋巴管静脉吻合术中，使用荧光素钠荧光显微镜集成淋巴管造影术可能优于ICG荧光。
