Chao Albert H, Schulz Steven A, Povoski Stephen P
Department of Plastic Surgery, Ohio State University, Columbus, OH, USA.
Department of Surgery, Division of Surgical Oncology, Ohio State University, Columbus, OH, USA.
Expert Rev Med Devices. 2021 Apr;18(4):367-374. doi: 10.1080/17434440.2021.1900725. Epub 2021 Mar 15.
Lymphedema has traditionally been managed through noninvasive means with complete decongestive therapy. However, complete decongestive therapy is an intensive program that requires lifelong adherence by patients with lymphedema. More recently, reconstructive surgical procedures have shown promise in improving lymphedema by physiologically restoring lymphatic function. One of these types of procedures, lymphaticovenular anastomosis, relies on technological advances in imaging, particularly indocyanine green lymphangiography.
This article reviews indocyanine green and near-infrared fluorescence imaging. In addition, this article discusses the application of this imaging to the preoperative, intraoperative, and postoperative assessment of the lymphatic system in the setting of lymphaticovenular anastomosis surgery.
Indocyanine green lymphangiography offers significant advantages over other types of imaging of the lymphatic system. In the future, it is hopeful that additional options for these imaging devices will become available which may increase their accessibility by centers interested in performing reconstructive lymphatic surgery, including in relation to cost. Finally, more studies with higher levels of evidence are needed to better define the long-term outcomes associated with lymphatic surgery including LVA. In this regard, practitioners should fully harness the information conferred by ICG lymphangiography as both a clinical and research tool.
传统上，淋巴水肿通过非侵入性手段进行完全减压治疗来管理。然而，完全减压治疗是一个密集的方案，需要淋巴水肿患者终身坚持。最近，重建性外科手术在通过生理恢复淋巴功能来改善淋巴水肿方面显示出前景。其中一种手术类型，即淋巴管静脉吻合术，依赖于成像技术的进步，特别是吲哚菁绿淋巴管造影术。
本文回顾了吲哚菁绿和近红外荧光成像。此外，本文讨论了这种成像在淋巴管静脉吻合术手术背景下对淋巴系统术前、术中和术后评估中的应用。
吲哚菁绿淋巴管造影术比其他类型的淋巴系统成像具有显著优势。未来，有望出现这些成像设备的更多选择，这可能会增加对进行重建性淋巴手术感兴趣的中心（包括在成本方面）对它们的可及性。最后，需要更多具有更高证据水平的研究，以更好地确定与包括淋巴管静脉吻合术在内的淋巴手术相关的长期结果。在这方面，从业者应充分利用吲哚菁绿淋巴管造影术提供的信息，将其作为一种临床和研究工具。
