Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze Della Salute Della Donna E Del Bambino E Di Sanità Pubblica, Unità di Chirurgia Plastica, Roma, Italy.
Università Cattolica del Sacro Cuore, Istituto di Clinica Chirurgica, Roma, Italy.
Microsurgery. 2019 Oct;39(7):605-612. doi: 10.1002/micr.30501. Epub 2019 Aug 10.
Pelvic lymphadenectomy (PL) causes changes to the inguinal lymph nodes with progressive loss of immune and lymphatic pump function. Efferent lymphatic vessel-to-venous anastomosis (ELVA) has been reported to address this problem. The aim of this report was to describe the feasibility of the SPECT/CT combined with ultrasound fusion imaging (UFI) to target the groin efferent lymph node (GELN) for ELVA.
Twelve patients with lower limb lymphedema after PL were scheduled for peripheric lymphaticovenular anastomosis (LVA) combined with ELVA. All-patients were clinically ISL-stage1, with good visualization of the inguinal lymph nodes at preoperative lymphoscintigraphy. The mean patient age was 55.4 years and the mean BMI was 25.5.The mean limb circumference (MLC) was calculated before surgery and 1 year after surgery. The LymQoL-Leg questionnaire was administered before surgery and 6 months after surgery. Before surgery, the GELN was identified by SPECT/CT and its location was marked on the skin by UFI virtual navigation. Peripheric LVA sites were planned by ultrasound and indocyanine green (ICG) lymphography. Pre and postoperative MLC and LymQoL-Leg scores were compared.
In all-patients, the SPECT/CT succeeded at detecting and targeting the GELN. In all-patients, real-time anatomical coregistration with US was feasible, and it was possible to mark on the groin skin the depth and position of the GELN on the skin at the groin. During surgery, in every patient, we found the GELN marked before surgery and performed ELVA. We also performed two or three peripheric LVAs in every patient. The mean value of MLC decreased (38.2 ± 2.13 cm vs. 36.33 ± 2.14 cm; p = .04) and the mean score of the LymQoL-Leg questionnaire improved (9.3 ± 1.7 vs. 7.7 ± 1.1; p = .02).
SPECT/CT combined with UFI is feasible for the preoperative identification of GELN for ELVA.
盆腔淋巴结清扫术（PL）会导致腹股沟淋巴结发生变化，使免疫和淋巴泵功能逐渐丧失。已有报道称，外分泌淋巴管-静脉吻合术（ELVA）可以解决这个问题。本研究旨在描述 SPECT/CT 联合超声融合成像（UFI）靶向腹股沟外分泌淋巴结（GELN）进行 ELVA 的可行性。
12 例 PL 后下肢淋巴水肿患者拟行外周淋巴管-静脉吻合术（LVA）联合 ELVA。所有患者均为临床 ISL 期 1 期，术前淋巴闪烁显像可良好显示腹股沟淋巴结。患者平均年龄为 55.4 岁，平均 BMI 为 25.5，平均肢体周长（MLC）在术前和术后 1 年进行计算。在术前和术后 6 个月使用 LymQoL-Leg 问卷进行评估。术前通过 SPECT/CT 识别 GELN，并通过 UFI 虚拟导航在皮肤上标记其位置。外周 LVA 部位通过超声和吲哚菁绿（ICG）淋巴管造影进行规划。比较术前和术后 MLC 及 LymQoL-Leg 评分。
所有患者的 SPECT/CT 均成功检测和定位 GELN。所有患者的实时解剖配准均可行，并能在腹股沟皮肤上标记 GELN 在皮肤上的深度和位置。术中，在所有患者中，我们都发现了术前标记的 GELN，并进行了 ELVA。此外，每位患者还进行了 2 至 3 次外周 LVA。MLC 的平均值降低（38.2±2.13cm 比 36.33±2.14cm；p=0.04），LymQoL-Leg 问卷的平均评分提高（9.3±1.7 比 7.7±1.1；p=0.02）。
SPECT/CT 联合 UFI 可用于术前识别 GELN 以进行 ELVA。
