Spiguel Lisa, Shaw Christiana, Katz Adam, Guo Lifei, Chen Hung-Chi, Lee Bernard T, Singhal Dhruv
From the *Department of Surgery; †Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Florida School of Medicine, Gainesville, FL; ‡Department of Plastic and Reconstructive Surgery, Lahey Clinic, Burlington, MA; §Department of Plastic and Reconstructive Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan; and ∥Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Ann Plast Surg. 2017 Jun;78(6S Suppl 5):S296-S298. doi: 10.1097/SAP.0000000000001034.
The Lymphatic Microsurgical Preventing Healing Approach (LYMPHA) procedure entails performing a lymphovenous bypass (LVB) at the time of axillary lymph node dissection to reduce lymphedema risk. The two most common fluorophores utilized in LVB are blue dye and indocyanine green. We developed a novel application of fluorescein isothiocyanate for intraoperative lymphatic mapping. Our goal is to demonstrate the safety and efficacy of fluorescein isothiocyanate for this application. We reviewed a prospectively collected database on breast cancer patients who underwent LYMPHA from March to September 2015. Fluorescein isothiocyanate was used to identify arm lymphatic channels after axillary lymph node dissection to perform an LVB between disrupted lymphatics and axillary vein tributaries. Data on preoperative and intraoperative variables were analyzed. Thirteen patients underwent LYMPHA with intraoperative fluorescein isothiocyanate lymphatic mapping from March to September 2015. Average patient age was 50 years with a mean body mass index of 28. On average, 3.4 lacerated lymphatic channels were identified at an average distance of 2.72 cm (range, 0.25-5 cm) caudal to the axillary vein. On average, 1.7 channels were bypassed per patient. Eleven anastomoses were performed to the accessory branch of the axillary vein and 1 to a lateral branch. In 1 patient, a bypass was not performed due to poor lymphatic caliber and inadequate length of the harvested vein tributary. No intraoperative adverse events were noted. Fluorescein isothiocyanate is a safe and effective method for intra-operative lymphatic mapping. Fluorescein isothiocyanate imaging allows for simultaneous dissection and lymphatic visualization, making it an ideal agent for lymphatic mapping and dissection in open surgical fields, such as in the LYMPHA procedure.
淋巴显微外科预防愈合方法（LYMPHA）手术需要在腋窝淋巴结清扫时进行淋巴管静脉搭桥术（LVB），以降低淋巴水肿风险。LVB中最常用的两种荧光团是蓝色染料和吲哚菁绿。我们开发了一种异硫氰酸荧光素在术中淋巴管造影的新应用。我们的目标是证明异硫氰酸荧光素在此应用中的安全性和有效性。我们回顾了一个前瞻性收集的关于2015年3月至9月接受LYMPHA手术的乳腺癌患者的数据库。异硫氰酸荧光素用于在腋窝淋巴结清扫后识别手臂淋巴管，以便在中断的淋巴管和腋窝静脉分支之间进行LVB。分析术前和术中变量的数据。2015年3月至9月，13例患者接受了术中异硫氰酸荧光素淋巴管造影的LYMPHA手术。患者平均年龄为50岁，平均体重指数为28。平均而言，在腋窝静脉尾侧平均距离2.72厘米（范围0.25 - 5厘米）处识别出3.4条撕裂的淋巴管。平均每位患者有1.7条淋巴管被搭桥。对腋窝静脉的副分支进行了11次吻合，对外侧分支进行了1次吻合。1例患者因淋巴管管径不佳和所采集静脉分支长度不足未进行搭桥。未观察到术中不良事件。异硫氰酸荧光素是一种安全有效的术中淋巴管造影方法。异硫氰酸荧光素成像可实现同步解剖和淋巴管可视化，使其成为开放手术领域（如LYMPHA手术）中淋巴管造影和解剖的理想试剂。
