Mihara Makoto, Hara Hisako, Kawakami Yoshihisa, Zhou Han Peng, Tange Shuichi, Kikuchi Kazuki, Iida Takuya
1 Department of lymphatic and Reconstructive Surgery, JR Tokyo, General Hospital , Tokyo, Japan .
2 Department of Plastic and Reconstructive Surgery, Fukuoka University , Fukuoka, Japan .
Lymphat Res Biol. 2018 Aug;16(4):360-367. doi: 10.1089/lrb.2017.0055. Epub 2018 Jan 17.
Histological changes in the collecting lymphatics in patients with lymphedema are classified as Normal type, Ectasis type, Contraction type, and Sclerosis type (NECST) classification. In this study, we investigated the condition of the lymphatic vessels in different sites of the legs.
We prospectively investigated the lymphatic vessels of patients with lymphedema who underwent lymphaticovenous anastomosis (LVA) from August 8, 2014 to August 4, 2015 based on the NECST classification. Lymphedema was diagnosed using lymphoscintigraphy, indocyanine green (ICG) lymphography, and the International Society of Lymphology (ISL) Classification. The affected limbs were divided into four sites: proximal thigh (Site 1), distal thigh (Site 2), proximal crus (Site 3), and distal crus (Site 4).
A total of 109 patients (205 limbs and 1028 lymphatics) were included in this study. Of the 109 patients, there were 100 women and 9 men with an average age of 61 years. The ratio of Ectasis type vessels increased toward the distal end of the limb with the highest occurrence rate being 54% at Site 4. As ISL stage, ICG stage, and lymphoscintigraphy stage advanced, so too did the ratio of Sclerosis type. In secondary lymphedema patients with lymphedema, the ratio of Ectasis type was more predominant in the distal end of the limb, whereas this tendency was not observed in primary lymphedema patients.
Sclerotic lymphatics are more predominantly found in the proximal limb whereas nonsclerotic vessels are more often found toward the distal end. These findings help lymphatic surgeon determine incision sites.
淋巴水肿患者集合淋巴管的组织学变化分为正常型、扩张型、收缩型和硬化型（NECST）分类。在本研究中，我们调查了腿部不同部位淋巴管的状况。
我们前瞻性地研究了2014年8月8日至2015年8月4日接受淋巴管静脉吻合术（LVA）的淋巴水肿患者的淋巴管，基于NECST分类。淋巴水肿通过淋巴闪烁显像、吲哚菁绿（ICG）淋巴管造影和国际淋巴学会（ISL）分类进行诊断。患侧肢体分为四个部位：大腿近端（部位1）、大腿远端（部位2）、小腿近端（部位3）和小腿远端（部位4）。
本研究共纳入109例患者（205条肢体和1028条淋巴管）。109例患者中，女性100例，男性9例，平均年龄61岁。扩张型血管的比例向肢体远端增加，在部位4发生率最高，为54%。随着ISL分期、ICG分期和淋巴闪烁显像分期的进展，硬化型的比例也增加。在继发性淋巴水肿患者中，扩张型在肢体远端更为常见，而在原发性淋巴水肿患者中未观察到这种趋势。
硬化性淋巴管在肢体近端更为常见，而非硬化性血管在远端更为常见。这些发现有助于淋巴管外科医生确定切口部位。
