Du Xingyi, Liu Chunjun
Plastic Surgery Hospital (Institute), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100043, China.
Gland Surg. 2020 Apr;9(2):582-588. doi: 10.21037/gs.2020.03.24.
Lymphedema is a chronic, progressive disease caused by primary or secondary reasons. It is currently uncurable and conservative compression therapy is generally applied. Lymphovenous anastomosis and vascularized lymph node transfer (VLNT) are two main surgical treatment that are used in addition to conservative therapy. Lymphovenous anastomosis involves the anastomosing remaining functional lymphatic vessels to vein. When the lymphatic vessels are greatly damaged and in no case can they be used for anastomosis, VLNT provide the affected area with lymph nodes from elsewhere to restore the drainage function. During all these procedures, a clear image to identify related lymphatic structures and venous vessels can be greatly useful for preoperative planning, intraoperative navigation, and postoperative evaluation. Lymphoscintigraphy used to be the gold standard in evaluating lymphedema and mapping lymphatic systems. But due to the downside of radiation, invasive operation and complication, other modalities are gaining attention. In this article, we reviewed the application of Indocyanine green (ICG) lymphography, ultrasound, magnetic resonance lymphography (MRL), and single-photon emission computed tomography-computed tomography (SPECT-CT) in the field of surgical therapy in lymphedema.
淋巴水肿是一种由原发性或继发性原因引起的慢性进行性疾病。目前无法治愈，一般采用保守压迫疗法。除保守治疗外，淋巴管静脉吻合术和带血管蒂淋巴结转移术（VLNT）是两种主要的外科治疗方法。淋巴管静脉吻合术是将剩余的有功能的淋巴管与静脉进行吻合。当淋巴管严重受损且无法用于吻合时，VLNT可将其他部位的淋巴结转移至患区以恢复引流功能。在所有这些手术过程中，清晰的图像对于识别相关淋巴结构和静脉血管，对术前规划、术中导航及术后评估都非常有用。淋巴闪烁造影术曾是评估淋巴水肿和绘制淋巴系统图谱的金标准。但由于存在辐射、侵入性操作及并发症等缺点，其他方法正受到关注。在本文中，我们综述了吲哚菁绿（ICG）淋巴造影、超声、磁共振淋巴造影（MRL）和单光子发射计算机断层扫描-计算机断层扫描（SPECT-CT）在淋巴水肿外科治疗领域的应用。
