Hara Hisako, Mihara Makoto
Department of Lymphatic and Reconstructive Surgery, Saiseikai Kawaguchi General Hospital, Saitama, Japan.
Eplasty. 2017 Mar 27;17:e11. eCollection 2017.
In this case report, we present a case wherein we observed a blocking of lymphatic vessels in indocyanine green lymphography and found a shrunken lymphatic vessel intraoperatively. We performed indocyanine green lymphography and lymphaticovenous anastomosis on a 77-year-old woman. She had previously undergone right mastectomy and axillary lymph node dissection accompanied by radiotherapy and chemotherapy for right breast cancer. She noticed swelling in the right upper limb 22 years after the surgery and consulted our hospital. Although she started wearing elastic sleeve, there was still stiffness in the right upper limb, and we decided to perform lymphaticovenous anastomosis 5 months after the first consultation. In the preoperative indocyanine green lymphography, we observed a linear pattern in the medial side of the right forearm, which suddenly blocked in the middle of the forearm. At that point, we observed dilated lymphatic vessels that were suddenly shrunken at the proximal side intraoperatively. We performed lymphaticovenous anastomosis with the dilated part of this lymphatic vessel. We also performed 4 additional lymphaticovenous anastomoses. The operation time was 2 hours 10 minutes, and the amount of bleeding was minimal. The right upper limb of the patient got softer, and she was satisfied with the result 3 months after the operation. The average circumference change at the 5 points in the right upper limb was -1.26 cm (range, -2.3 to -0.3 cm). There was a possibility that the blocking of the lymphatic vessels was a cause of lymphedema in the upper extremity.
在本病例报告中，我们呈现了一例在吲哚菁绿淋巴造影中观察到淋巴管阻塞且术中发现淋巴管变细的病例。我们对一名77岁女性进行了吲哚菁绿淋巴造影和淋巴管静脉吻合术。她此前因右乳腺癌接受了右乳房切除术和腋窝淋巴结清扫术，并伴有放疗和化疗。术后22年她注意到右上肢肿胀，遂到我院就诊。尽管她开始佩戴弹力袖套，但右上肢仍有僵硬感，于是在首次就诊5个月后我们决定进行淋巴管静脉吻合术。在术前吲哚菁绿淋巴造影中，我们在右前臂内侧观察到一条线性影像，该影像在前臂中部突然中断。术中我们观察到扩张的淋巴管在近端突然变细。我们对该淋巴管的扩张部分进行了淋巴管静脉吻合术。我们还额外进行了4次淋巴管静脉吻合术。手术时间为2小时10分钟，出血量极少。患者的右上肢变得更柔软，术后3个月她对结果感到满意。右上肢5个点的平均周长变化为 -1.26厘米（范围为 -2.3至 -0.3厘米）。淋巴管阻塞有可能是上肢淋巴水肿的一个原因。
