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Volume 66, Issue 9 （September 2023）

形成外科 66巻9号（2023年9月発行）

Japanese English

特集効率よいリンパ外科への道標

Multiple injection ICG蛍光リンパ管造影法 Multiple-Injection ICG Fluorescent Lymphography 北山晋也 ¹ , 大井皓介 ¹ , 出原薫 ¹ , 梅田龍 ¹ , 山本優子 ¹ , 林礼人 ¹ , 前川二郎 ² Shinya Kitayama ¹ , Kosuke Ooi ¹ , Kaoru Izuhara ¹ , Ryu Umeda ¹ , Yuko Yamamoto ¹ , Ayato Hayashi ¹ , Jiro Maegawa ² ¹横浜市立大学医学部形成外科 ²藤沢市保健医療センター ¹Department of Plastic and Reconstructive Surgery, Yokohama City University School of Medicine ²Fujisawa City Health and Medical Center pp.1020-1028

発行日 2023年9月10日 Published Date 2023/9/10

DOI https://doi.org/10.18916/keisei.2023090007

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Abstract 文献概要
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参考文献 Reference

はじめに

　効率的なリンパ管静脈吻合術（lymphaticovenou anastomosis：以下，LVA）を行ううえで，吻合に適したリンパ管を同定することが必要である。ICG蛍光リンパ管造影は手術時のリンパ管描出に多用されるが，描出されるリンパ管の状態はさまざまであり，より多くのリンパ管を描出することでよりよいリンパ管を選択することが可能となる。また，重症例などにおいてはリンパ管の障害が進行するため，足部の注入のみでは必要十分なリンパ管の描出が困難なこともある。われわれは2019年よりICGを足部より近位のさまざまな部位に注入するmultiple injection ICG蛍光リンパ管造影法（以下，multiple injection法）を行い，効率的なLVAを行うことを心がけてきた。本稿ではmultiple injection法の概要を説明するとともに，代表的な症例を提示し，現在までの経験から得られている知見に関して若干の文献的考察を加え紹介する。

　ICG fluorescence lymphangiography is often used to identify lymphatic vessels during a lymphaticovenous anastomosis（LVA）procedure. However, the condition of the detected lymphatic vessels varies widely, and in some cases, a sufficient number of lymphatic vessels for anastomosis is not identified. For an efficient LVA, we have performed multiple-injection ICG lymphangiography in which ICG is injected into various areas of the affected limb. In the multiple-injection method, ICG is first injected into interdigital spaces, and ICG injections are administered one after another into the area where neither the linear pattern（LP）nor dermal backflow（DBF）has appeared, thereby mapping the lymphatics of the entire limb. In many cases, more lymphatic vessels appear than when ICG is injected only in the foot, allowing for a more efficient LVA.

　We investigated the LP appearance rate for lower extremities in which the LVA was performed using the multiple-injection method, and we observed that the LP appearance rate was significantly higher in the lower leg than in the thigh. In the lower leg, the LP appearance rate was significantly higher in the lateral region than in the medial region. A comparison by severity showed that the LP appearance rate in the medial region declined rapidly in the more-than-moderate severity cases, whereas it remained relatively high in the lateral region of the lower leg until severe disease. These results might reflect the characteristics of the lymphosome.

　In the diagnosis and treatment of lymphedema, it is important to understand the concept of the lymphosome and its characteristics. The multiple-injection method is useful for performing efficient LVAs, as its use identifies as many lymphatic vessels as possible.