Zhu Haoxiang, Zhu Huipeng, Bao Yuanjie
Department of Vascular Surgery, The Affiliated People's Hospital of Ningbo University, China.
Department of Hepatobiliary Surgery, The Affiliated People's Hospital of Ningbo University, China.
J Int Med Res. 2025 Sep;53(9):3000605251375258. doi: 10.1177/03000605251375258. Epub 2025 Sep 10.
This study explores effective treatment methods for chronic secondary lymphedema after radical cervical cancer surgery combined with pelvic lymphadenectomy. In cases where conservative treatment was ineffective, we investigated whether multiple injections of indocyanine green can effectively improve the outcomes of lymphatic-venous anastomosis under microscopy. Preoperative lymphatic imaging was used to localize functional vessels, guiding distal left lower limb lymphatic reconstruction. Intraoperatively, supermicroscopy (40×) and real-time indocyanine green imaging enabled eight end-to-end anastomoses between 0.5- and 1.3-mm lymphatic capillaries and subcutaneous veins. Each anastomosis took ≤30 min, with intraoperative lymphangiography confirming patency. Immediate postoperative lymphatic diversion to veins was observed. By day 3, reconstructed pathway efficiency reached 83% of the healthy side, with visual analog scale pain scores decreasing from 5 to 2. At 3-6 months, mid-thigh and calf circumferences reduced progressively; ultrasound confirmed edema resolution and complete cessation of exudation. High-precision multipoint supermicrosurgical anastomosis achieved anatomical and functional reconstruction of chronic secondary lymphedema, overcoming traditional size and functional limitations. Innovations included multipoint design to prevent reobstruction and dynamic imaging-guided precision. This case establishes a radical treatment strategy for chronic secondary lymphedema.
本研究探讨根治性宫颈癌手术联合盆腔淋巴结清扫术后慢性继发性淋巴水肿的有效治疗方法。在保守治疗无效的病例中，我们研究多次注射吲哚菁绿是否能有效改善显微镜下淋巴静脉吻合的效果。术前淋巴成像用于定位功能血管，指导左下肢远端淋巴重建。术中，超显微镜（40倍）和实时吲哚菁绿成像实现了0.5至1.3毫米的毛细淋巴管与皮下静脉之间的8次端端吻合。每次吻合耗时≤30分钟，术中淋巴管造影证实通畅。术后立即观察到淋巴引流至静脉。到第3天，重建通路效率达到健侧的83%，视觉模拟评分疼痛分数从5分降至2分。在3至6个月时，大腿中部和小腿周长逐渐减小；超声证实水肿消退且渗出完全停止。高精度多点超显微手术吻合实现了慢性继发性淋巴水肿的解剖和功能重建，克服了传统的尺寸和功能限制。创新之处包括多点设计以防止再阻塞和动态成像引导下的精准性。本病例确立了慢性继发性淋巴水肿的根治性治疗策略。
