Nuri Takashi, Asaka Akinori, Ota Mariko, Yae Yuri, Tanaka Yoshimichi, Osuga Keigo, Takashima Shogo, Ohmichi Masahide, Otsuki Yuki, Ueda Koichi
From the Department of Plastic and Reconstructive Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan.
Department of Obstetrics and Gynecology, Osaka Medical and Pharmaceutical University, Osaka, Japan.
Plast Reconstr Surg Glob Open. 2024 Sep 6;12(9):e6134. doi: 10.1097/GOX.0000000000006134. eCollection 2024 Sep.
Lymphatic ascites is an infrequent complication observed in patients who have undergone lymphadenectomy as part of their surgical treatment for gynecological cancer. Previous research has suggested that intranodal lymphangiography can effectively manage lymphatic leakage. However, its efficacy diminishes for ascites with substantial fluid accumulation. This case report presents a patient who underwent lymphaticovenous anastomosis (LVA) for ascites that was unresponsive to lymphangiography and sclerotherapy. A 70-year-old woman required weekly ascites punctures after surgical treatment of ovarian cancer. Lymphoscintigraphy revealed lymphatic leakage originating from the right pelvic lymphatic vessel. Intranodal lymphangiography was performed from the inferior lateral inguinal region, followed by embolization with 33% NBCA. Despite these measures, recurrence of ascites and lower limb lymphedema were observed. LVA was conducted at 149 days after the primary operation. Before the LVA, indocyanine green was injected into the lateral and medial ankles, first and fourth toe web spaces, and lower abdomen. The indocyanine green lymphography revealed several linear patterns extending from the dorsum of the foot and the lower abdomen to the inguinal lymph node. Among these, the lymphatic vessels leading to the inferior lateral inguinal lymph node were chosen for the LVA. Eight anastomoses were executed at the right thigh, right lower leg, and right lower abdomen. The patient was discharged at 1 day postoperatively. A computed tomography examination conducted at 20 days post-LVA revealed no accumulation of ascites. To improve the success rate of LVA for ascites, a treatment strategy based on lymphatic territories is required.
淋巴性腹水是妇科癌症手术治疗中接受淋巴结清扫术的患者中罕见的并发症。先前的研究表明，结内淋巴管造影可有效处理淋巴漏。然而，对于大量积液的腹水，其疗效会降低。本病例报告介绍了一名接受淋巴静脉吻合术（LVA）治疗的患者，该患者的腹水对淋巴管造影和硬化治疗均无反应。一名70岁女性在卵巢癌手术治疗后需要每周进行腹水穿刺。淋巴闪烁造影显示淋巴漏起源于右盆腔淋巴管。从腹股沟下外侧区域进行结内淋巴管造影，随后用33%的NBCA进行栓塞。尽管采取了这些措施，但仍观察到腹水复发和下肢淋巴水肿。在初次手术后149天进行了LVA。在LVA之前，将吲哚菁绿注入内外踝、第一和第四趾蹼间隙以及下腹部。吲哚菁绿淋巴管造影显示从足背和下腹部延伸至腹股沟淋巴结的几条线性路径。其中，选择通向腹股沟下外侧淋巴结的淋巴管进行LVA。在右大腿、右小腿和右下腹部进行了8处吻合。患者术后1天出院。LVA后20天进行的计算机断层扫描检查显示无腹水积聚。为提高LVA治疗腹水的成功率，需要一种基于淋巴区域的治疗策略。
