Department of Lymphatic and Reconstructive Surgery, JR Tokyo General Hospital, Tokyo, Japan.
Lymphedema Clinic Tokyo, Tokyo, Japan.
J Plast Reconstr Aesthet Surg. 2024 Dec;99:289-296. doi: 10.1016/j.bjps.2024.09.072. Epub 2024 Sep 27.
The management of lymphatic vesicles is challenging. This study aimed to clarify the lymphatic flow around the genitals and assess the effect of genital lymphaticovenous anastomosis (LVA) on lymphatic vesicles.
We conducted a retrospective study of 34 patients who underwent lymphatic vesicle resection and LVA. In patients with genital lymphedema, 2 types of lymphatic inflow existed around the genital area; from the lower extremities (type 1) and from the buttocks (type 2). Lymphoscintigraphy was performed to detect type 1 lymphatics injecting isotope into the first interdigital area. Indocyanine green (ICG) lymphography was performed to detect type 2 lymphatics injecting ICG into the ischial tuberosity. Lymphatic vesicles were resected, and LVA was performed on the legs and/or genitals. Postoperative recurrence rate of lymphatic vesicles and the frequency of cellulitis were evaluated.
Type 1 lymphatics were observed in 38.2% of the patients. ICG lymphography showed a linear inflow to the genitals in 40.9% and dermal backflow inflow in 24.2%. Both type 1 and 2 lymphatic vessels were observed in 10 patients (29.4%). Genital LVA was performed in 31 patients and lower extremity LVA was performed in 15 patients. The average follow-up period was 332 days, and recurrence was observed in 8 (25.8%) of 31 patients who underwent total resection. The average number of cellulitis episodes decreased significantly from 2.8 times before surgery to 0.31 times after surgery (p < 0.01).
LVA in the genital area and lower limbs was effective in preventing postoperative recurrence of lymphatic vesicles after resection.
淋巴管的管理具有挑战性。本研究旨在阐明生殖器周围的淋巴液流动，并评估生殖器淋巴静脉吻合术（LVA）对淋巴管的影响。
我们对 34 例接受淋巴管切除术和 LVA 的患者进行了回顾性研究。在生殖器淋巴水肿患者中，生殖器区域周围存在 2 种类型的淋巴液流入；来自下肢（1 型）和来自臀部（2 型）。通过向第一指间区域注射示踪剂进行淋巴闪烁显像术来检测 1 型淋巴管。通过向坐骨结节注射吲哚菁绿（ICG）进行 ICG 淋巴造影术来检测 2 型淋巴管。切除淋巴管，并在腿部和/或生殖器上进行 LVA。评估术后淋巴管复发率和蜂窝织炎的频率。
38.2%的患者观察到 1 型淋巴管。ICG 淋巴造影术显示 40.9%的线性流入生殖器，24.2%的真皮回流流入。10 例患者（29.4%）观察到 1 型和 2 型淋巴管。31 例患者行生殖器 LVA，15 例患者行下肢 LVA。平均随访时间为 332 天，31 例完全切除患者中有 8 例（25.8%）复发。术前蜂窝织炎发作次数平均为 2.8 次，术后减少至 0.31 次（p<0.01）。
生殖器和下肢的 LVA 对预防淋巴管切除术后淋巴管复发是有效的。
