Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea.
Ann Surg Oncol. 2024 Jun;31(6):3694-3704. doi: 10.1245/s10434-024-15113-2. Epub 2024 Mar 26.
Vascularized gastroepiploic lymph node transfer (VGLNT) is a well-accepted surgical treatment for restoring physiological function in chronic lymphedema. However, the inclusion of substantial lymph nodes (LNs) in the flap remains uncertain. This study aimed to identify the anatomical basis for reliable flap harvest for VGLNT.
The anatomy of perigastric station 4d LNs was studied in healthy cadavers (n = 15) and patients with early gastric cancer (EGC) (n = 27). The omentum was divided into three segments: proximal, middle, and distal from the origin of the right gastroepiploic vessels. The flap dimension, number, location, size of LNs, and caliber of the vessels were reviewed. Eight patients underwent VGLNT for upper/lower limb lymphedema.
The mean numbers of LNs in the proximal, middle, and distal segment were 2.5, 1.4, 0.5 in the cadavers, and 4.9, 2.7, 0.7 in the gastrectomy specimens, respectively. The proximal third included a significantly greater number of LNs than the distal third in the cadaveric (p = 0.024) and ECG (p = 0.016) specimens. A total of 95% of the LNs were located within proximal two-thirds of the flap from the vessel origin both in the cadavers (21.0 × 5.0 cm) and in the gastrectomy specimens (20 × 3.5 cm). In VGLNT, the transferred flap was 25.5 ± 6.9 × 4.1 + 0.7 cm in dimension, containing a mean number of 6.5 ± 1.9 LNs. At postoperative 6 months, the volumetric difference was significantly reduced by 22.8 ± 9.2% (p < 0.001).
This study provides a distinct distribution pattern of station 4d LNs. Inclusion of the proximal two-thirds of the flap, which carries majority of the LNs, is recommended for VGLNT.
血管化胃网膜淋巴结转移（VGLNT）是一种被广泛接受的治疗慢性淋巴水肿的手术方法，可恢复其生理功能。然而，皮瓣中包含大量的淋巴结（LNs）仍然存在不确定性。本研究旨在为 VGLNT 可靠的皮瓣采集提供解剖学基础。
在健康尸体（n=15）和早期胃癌（EGC）患者（n=27）中研究胃周站 4d 淋巴结的解剖结构。将大网膜分为三个节段：以右胃网膜血管的起点为界，近端、中间和远端。回顾皮瓣的大小、数量、位置、淋巴结的大小和血管的口径。8 例患者因上下肢淋巴水肿行 VGLNT。
尸体标本中，近端、中间和远端节段的平均淋巴结数量分别为 2.5、1.4、0.5，胃切除标本中分别为 4.9、2.7、0.7。尸体标本（p=0.024）和 EGC 标本（p=0.016）中，近端三分之一的淋巴结数量明显多于远端三分之一。在尸体标本（21.0×5.0cm）和胃切除标本（20×3.5cm）中，95%的淋巴结均位于血管起点近端三分之二的皮瓣内。在 VGLNT 中，转移皮瓣的大小为 25.5±6.9×4.1+0.7cm，平均包含 6.5±1.9 个淋巴结。术后 6 个月，体积差异显著减少 22.8±9.2%（p<0.001）。
本研究提供了站 4d 淋巴结的明确分布模式。建议在 VGLNT 中包含包含多数淋巴结的皮瓣近端三分之二。
