Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
Lymphat Res Biol. 2021 Dec;19(6):539-544. doi: 10.1089/lrb.2019.0088. Epub 2021 Feb 9.
Assessment of lymph flow has proven challenging. Transit-time ultrasound technique (TTUT) is the first technique that provides real-time quantitative lymphatic flow values. In cardiothoracic surgery and neurosurgery, this technique has tremendous clinical value in assessing surgery quality and predicting outcomes. The objective of this study was to measure lymph flow before and after lymphaticovenous anastomosis (LVA), using TTUT. Consecutive patients with peripheral lymphedema undergoing LVA were included. Preoperative workup was performed using indocyanine green (ICG) lymphangiography. Perioperatively, the Transonic Microvascular Flowprobe was used to measure lymph flow before and after anastomosis. Twenty-five patients with International Society of Lymphology stage IIA (68%) and stage IIB (32%) peripheral lymphedema were included. Lymph flow velocities ranged from 0.02 to 0.80 mL/min (mean 0.25 ± 0.19) before anastomosis and from 0.02 to 0.86 mL/min (mean 0.27 ± 0.22) after anastomosis ( = 0.340). Mean flow values were significantly higher in the upper extremities compared with the lower extremities. Furthermore, there was a decrease in flow in patients with ICG stage IV in comparison with ICG stage III. Clinical outcomes could not be directly correlated with flow values in these individual cases. TTUT micro-flowprobe is a suitable instrument to measure real-time quantitative lymphatic flow in both lymphatics and LVA. It can confirm patency of lymphatic collectors and LVA peroperatively. Significantly higher lymph flow velocities were found in upper extremities in comparison with lower extremities, both before and after LVA. Further studies should be performed to evaluate lymph flow values and clinical correlation.
淋巴流量评估一直具有挑战性。瞬时超声技术（TTUT）是第一种提供实时定量淋巴流量值的技术。在心胸外科和神经外科中，该技术在评估手术质量和预测结果方面具有巨大的临床价值。本研究的目的是使用 TTUT 测量淋巴吻合术（LVA）前后的淋巴流量。纳入接受 LVA 的外周性淋巴水肿患者。术前采用吲哚菁绿（ICG）淋巴管造影术进行术前检查。术中使用 Transonic 微血管流量探头测量吻合前后的淋巴流量。纳入 25 例国际淋巴学会（ISL）ⅡA 期（68%）和ⅡB 期（32%）外周性淋巴水肿患者。淋巴流速范围为 0.02-0.80ml/min（平均 0.25±0.19ml/min），吻合前为 0.02-0.86ml/min（平均 0.27±0.22ml/min）（P=0.340）。与下肢相比，上肢的平均流量值明显较高。此外，与 ICG Ⅲ期相比，ICG Ⅳ期患者的流量减少。在这些个别病例中，临床结果无法直接与流量值相关联。TTUT 微流量探头是一种测量淋巴管和 LVA 实时定量淋巴流量的合适仪器。它可以在术中确认淋巴管收集器和 LVA 的通畅性。与下肢相比，上肢在 LVA 前后的淋巴流速均明显较高。应进一步开展研究，以评估淋巴流量值与临床相关性。
