Hara Hisako, Mihara Makoto, Ohtomo Rie, Tanaka Sayuri
Department of Lymphatic and Reconstructive Surgery, JR Tokyo General Hospital, Tokyo, Japan.
Department of Pathology, JR Tokyo General Hospital, Tokyo, Japan.
Plast Reconstr Surg Glob Open. 2019 May 24;7(5):e2268. doi: 10.1097/GOX.0000000000002268. eCollection 2019 May.
Lymphatic thrombosis is rarer than venous thrombosis. This case report describes a patient with secondary lymphedema, who was found to have lymphatic thrombosis during lymphaticovenous anastomosis (LVA). A 51-year-old woman underwent hysterectomy and pelvic lymph node dissection for uterine cancer when she was 48 years old, and lymphedema developed in the left leg soon after the operation. She was diagnosed with lymphedema based on lymphoscintigraphic finding. Preoperative echography showed 2 hypoechoic circles measuring about 0.5 mm in diameter that did not collapse with pressure from the probe, although the veins collapsed with pressure. We diagnosed the 2 hypoechoic circles as lymphatic vessels based on the location and longitudinal continuity. During LVA, we identified 2 parallel white vessels beneath the superficial fascia. After they were cut, white material was extruded. A diagnosis of lymphatic thrombosis was made, and we ligated the lymphatic vessels, closed the wound at this site, and performed LVA at other sites (4 sites in the left and 1 site in the right leg). The postoperative course was uneventful. Histopathological examination showed hyperplasty of fibroblasts and organization in the thrombus. Lymphatic thrombosis is sometimes found in the lymphedema-affected extremities. On retrospective consideration, lymphatic thrombosis can be detected with preoperative echography.
淋巴系统血栓形成比静脉系统血栓形成更为罕见。本病例报告描述了一名继发性淋巴水肿患者，在进行淋巴管静脉吻合术（LVA）时发现存在淋巴系统血栓形成。一名51岁女性在48岁时因子宫癌接受了子宫切除术和盆腔淋巴结清扫术，术后不久左腿出现淋巴水肿。根据淋巴闪烁造影检查结果，她被诊断为淋巴水肿。术前超声检查显示有两个直径约0.5毫米的低回声环，探头施压时不塌陷，而静脉受压时会塌陷。根据其位置和纵向连续性，我们将这两个低回声环诊断为淋巴管。在进行LVA时，我们在浅筋膜下方发现了两条平行的白色血管。切断血管后，有白色物质挤出。诊断为淋巴系统血栓形成，我们结扎了淋巴管，在此部位关闭伤口，并在其他部位（左腿4处，右腿1处）进行了LVA。术后过程顺利。组织病理学检查显示血栓内有成纤维细胞增生和机化。在受淋巴水肿影响的肢体中有时会发现淋巴系统血栓形成。经回顾性分析，术前超声检查可以检测到淋巴系统血栓形成。
