Narushima Mitsunaga, Yamamoto Takumi, Ogata Fusa, Yoshimatsu Hidehiko, Mihara Makoto, Koshima Isao
Department of Plastic and Reconstructive Surgery, Tokyo University School of Medicine, Bunkyo-ku, Tokyo, Japan.
Department of Cardiovascular Medicine, Tokyo University School of Medicine, Bunkyo-ku, Tokyo, Japan.
J Reconstr Microsurg. 2016 Jan;32(1):72-9. doi: 10.1055/s-0035-1564608. Epub 2015 Sep 30.
Indocyanine green (ICG) lymphography is one of several methods of lymphography to detect lymphatic channels and evaluate patients clinically with limb lymphedema. ICG imaging is made possible by the use of a near-infrared camera device. The fluorescence images were digitalized for real-time display.
ICG lymphography findings are largely classifiable into two patterns: normal linear pattern and abnormal dermal backflow (DB) pattern. ICG lymphography pattern changes from the normal linear pattern to abnormal DB patterns in obstructive peripheral lymphedema; with progression of lymphedema, DB patterns change from splash pattern, to stardust pattern, and finally to diffuse pattern. We classify ICG lymphography progression into 0 to V stages for the upper extremity, the lower extremity and into 0 to IV stages for the genital area.
In DB stage II, most patients are symptomatic; thus, aggressive treatments, such as lymphaticovenular anastomosis, are indicated. In DB stages III to V, lymphaticovenular anastomosis is recommended because most patients are refractory to conservative therapies.
吲哚菁绿（ICG）淋巴造影是检测淋巴管和对肢体淋巴水肿患者进行临床评估的几种淋巴造影方法之一。通过使用近红外摄像设备可实现ICG成像。荧光图像被数字化以进行实时显示。
ICG淋巴造影结果在很大程度上可分为两种模式：正常线性模式和异常真皮反流（DB）模式。在阻塞性外周淋巴水肿中，ICG淋巴造影模式从正常线性模式转变为异常DB模式；随着淋巴水肿的进展，DB模式从飞溅模式转变为星尘模式，最终转变为弥漫模式。我们将上肢、下肢的ICG淋巴造影进展分为0至V期，将生殖器区域的ICG淋巴造影进展分为0至IV期。
在DB II期，大多数患者有症状；因此，需要采取积极的治疗方法，如淋巴管静脉吻合术。在DB III至V期，建议进行淋巴管静脉吻合术，因为大多数患者对保守治疗无效。
