1Department of Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL.
2Department of Anesthesiology, College of Medicine, University of Florida, Gainesville, FL.
J Am Vet Med Assoc. 2023 Jul 31;261(11):1-9. doi: 10.2460/javma.23.04.0206. Print 2023 Nov 1.
To compare the effect of a geometric, landmark-guided lymphadenectomy (LL) approach to peripheral lymph nodes (LNs) on successful LN identification, surgical time, tissue trauma, and ease of LN identification compared to standard lymphadenectomy (SL) and methylene blue-guided lymphadenectomy (MBL).
18 adult, mixed-breed canine cadavers operated on by 7 veterinarians and 5 fourth-year veterinary students between July 23 and October 12, 2022.
Participants were provided standardized, publicly available materials regarding the anatomy and surgical techniques for SL of 3 peripheral lymphocentrums: superficial cervical, axillary (ALN), and superficial inguinal (SILN). Participants performed the 3 SLs unilaterally on canine cadavers. Thereafter, they were randomly assigned to 2 crossover groups: MBL and LL. All dissections were separated by at least 2 weeks for each participant. Primary outcome measures included successful LN identification, surgical time, tissue trauma scores, and subjective difficulty.
Successful LN identification was highest with LL (86%) compared to SL (69%) and MBL (67%). Subjective difficulty scores were reduced with LL for SILN dissections. Tissue trauma scores were reduced when using LL for ALN and SILN compared to MBL and SL. Time to LN identification was reduced for ALN with LL. No significant differences were observed between MBL and SL, or for the superficial cervical dissections.
Peripheral lymphadenectomies are time consuming and difficult for veterinarians in early stages of surgical training. Little surgical guidance is provided within current literature. Geometric, landmark-guided lymphadenectomies may improve LN identification success and reduce surgical time, tissue trauma, and procedure difficulty, which could encourage their clinical application.
比较几何标志引导的外周淋巴结（LN）淋巴结切除术（LL）与标准淋巴结切除术（SL）和亚甲蓝引导的淋巴结切除术（MBL）在成功识别 LN、手术时间、组织创伤和 LN 识别简便性方面的效果。
2022 年 7 月 23 日至 10 月 12 日，7 名兽医和 5 名四年级兽医学生对 18 只成年、混合品种犬进行了手术。
为参与者提供了关于 SL 三个外周淋巴结中心（颈浅、腋窝（ALN）和腹股沟浅（SILN））的解剖结构和手术技术的标准化、公开可用的材料。参与者在犬尸体上单侧进行了 3 次 SL。此后，他们被随机分配到 2 个交叉组：MBL 和 LL。每位参与者之间至少间隔 2 周进行所有解剖。主要观察指标包括成功识别 LN、手术时间、组织创伤评分和主观难度。
与 SL（69%）和 MBL（67%）相比，LL 组 LN 识别成功率最高（86%）。对于 SILN 解剖，LL 组的主观难度评分降低。与 MBL 和 SL 相比，LL 用于 ALN 和 SILN 时组织创伤评分降低。使用 LL 时，ALN 的 LN 识别时间缩短。MBL 和 SL 之间，或颈浅淋巴结解剖之间无明显差异。
外周淋巴结切除术对于处于手术训练早期阶段的兽医来说既耗时又困难。目前的文献中提供的手术指导很少。几何标志引导的淋巴结切除术可能提高 LN 识别成功率，缩短手术时间、组织创伤和手术难度，从而鼓励其临床应用。
