Lipman Kelsey, Luan Anna, Stone Kimberly, Wapnir Irene, Karin Mardi, Nguyen Dung
Division of Plastic and Reconstruction Surgery, Stanford University, Stanford, CA 94304, USA.
Division of Breast Surgery, Stanford University, Stanford, CA 94304, USA.
J Clin Med. 2021 Dec 24;11(1):92. doi: 10.3390/jcm11010092.
While surgical options exist to treat lymphedema after axillary lymph node dissection (ALND), the lymphatic microsurgical preventive healing approach (LYMPHA) has been introduced as a preventive measure performed during the primary surgery, thus avoiding the morbidity associated with lymphedema. Here, we highlight details of our operative technique and review postoperative outcomes. For our patients, limb measurements and body composition analyses were performed pre- and postoperatively. Intraoperatively, axillary reverse lymphatic mapping was performed with indocyanine green (ICG) and lymphazurin. SPY-PHI imaging was used to visualize the ICG uptake into axillary lymphatics. Cut lymphatics from excised nodes were preserved for lymphaticovenous anastomosis (LVA). At the completion of the microanastomosis, ICG was visualized draining from the lymphatic through the recipient vein. A retrospective review identified nineteen patients who underwent complete or partial mastectomy with ALND and subsequent LYMPHA over 19 months. The number of LVAs performed per patient ranged between 1-4 per axilla. The operating time ranged from 32-95 min. There were no surgical complications, and thus far one patient developed mild lymphedema with an average follow up of 10 months. At the clinic follow up, ICG and SPY angiography were used to confirm intact lymphatic conduits with an uptake of ICG across the axilla. This study supports LYMPHA as a feasible and effective method for lymphedema prevention.
虽然存在手术方法来治疗腋窝淋巴结清扫术（ALND）后的淋巴水肿，但淋巴显微外科预防性愈合方法（LYMPHA）已被引入作为在初次手术期间采取的预防措施，从而避免与淋巴水肿相关的发病率。在此，我们重点介绍我们的手术技术细节并回顾术后结果。对于我们的患者，在术前和术后进行肢体测量和身体成分分析。术中，使用吲哚菁绿（ICG）和亚甲蓝进行腋窝逆向淋巴管造影。使用SPY-PHI成像来观察ICG被腋窝淋巴管摄取的情况。将切除淋巴结中切断的淋巴管保留用于淋巴静脉吻合术（LVA）。在显微吻合完成时，观察到ICG从淋巴管通过受纳静脉引流。一项回顾性研究确定了19名患者，他们在19个月内接受了全乳或部分乳房切除术及随后的ALND和LYMPHA。每位患者每侧腋窝进行LVA的数量在1至4个之间。手术时间为32至95分钟。没有手术并发症，到目前为止，1例患者出现轻度淋巴水肿，平均随访10个月。在门诊随访时，使用ICG和SPY血管造影来确认完整的淋巴管，且ICG在腋窝有摄取。本研究支持LYMPHA作为一种预防淋巴水肿的可行且有效的方法。
