Weiss M, Baumeister R G, Tatsch K, Hahn K
Klinik und Poliklinik für Nuklearmedizin, Ludwig-Maximilians-Universität München, Deutschland.
Nuklearmedizin. 1996 Dec;35(6):236-42.
Autologous lymph vessel transplantation significantly improves the lymphdrainage in patients with primary and secondary lymphedema. The aim of the present study was to answer the question, whether scintigraphic long-term follow up and semiquantitative evaluation of lymphatic flow could prove the persisting success of this sophisticated microsurgical technique.
In this study visual and semiquantitative lymphoscintigraphy was used to prove the function of lymphatic vessel grafts in 20 patients (17 females, 3 males) comparing a preoperative baseline study with postoperative follow up investigations for a period of 7 years. The reason for microsurgical lymph vessel transplantation was in 4 patients a primary and in 16 patients a secondary lymphedema. In 12 cases the transplantation site was at the upper extremity, in 8 cases at the lower limb.
In 17/20 patients lymphatic function significantly improved after autologous lymph vessel transplantation compared to the preoperative findings, as verified by visual improvement of lymph drainage and decrease of a numeric transportindex. In 5 cases the vessel graft could be directly visualized. In these patients with scintigraphic visualization of the vessel graft the transportindex decreases to a significantly greater extent compared to the preoperative baseline study. Only 3 patients did not benefit from microsurgical treatment
Lymphoscintigraphy combined with semiquantitative estimation of lymphatic transport kinetics has shown to be an easy, reliable and readily available technique to assess lymphatic function before and after autologous lymph vessel transplantation. Thus, the method is not only helpful in planning microsurgical treatment but also in monitoring the postoperative improvement of lymph drainage. Patients with scintigraphic visualization of the vessel graft showed a significant better postoperative outcome than those without. The scintigraphic visualization of the vessel graft therefore seems to indicate a favourable prognosis regarding to lymph drainage.
自体淋巴管移植可显著改善原发性和继发性淋巴水肿患者的淋巴引流。本研究的目的是回答以下问题，即淋巴管闪烁成像长期随访和淋巴流的半定量评估能否证实这种复杂显微外科技术的持续成功。
在本研究中，采用视觉和半定量淋巴闪烁成像来证实20例患者（17例女性，3例男性）淋巴管移植的功能，将术前基线研究与术后长达7年的随访调查进行比较。显微外科淋巴管移植的原因，4例为原发性淋巴水肿，16例为继发性淋巴水肿。12例移植部位在上肢，8例在下肢。
与术前结果相比，20例患者中有17例自体淋巴管移植后淋巴功能显著改善，这通过淋巴引流的视觉改善和数字转运指数的降低得到证实。5例可直接观察到移植的淋巴管。在这些能通过闪烁成像观察到移植淋巴管的患者中，与术前基线研究相比，转运指数下降幅度更大。只有3例患者未从显微外科治疗中获益。
淋巴闪烁成像结合淋巴转运动力学的半定量评估已被证明是一种简单、可靠且易于获得的技术，可用于评估自体淋巴管移植前后的淋巴功能。因此，该方法不仅有助于规划显微外科治疗，还可用于监测术后淋巴引流的改善情况。能通过闪烁成像观察到移植淋巴管的患者术后结果明显优于未观察到的患者。因此，移植淋巴管的闪烁成像似乎预示着淋巴引流的良好预后。
