[1]赵锦丽,刘光新,于鹤.不同部位注射吲哚菁绿示踪下肢淋巴回流通路及子宫旁淋巴回流通路观察[J].新乡医学院学报,2024,(3):262-265.[doi:10.7683/xxyxyxb.2024.03.012]
　ZHAO Jinli,LIU Guangxin,YU He.Observations of lower limb lymphatic reflux and para-uterine lymphatic reflux by injecting indocyanine green[J].Journal of Xinxiang Medical University,2024,(3):262-265.[doi:10.7683/xxyxyxb.2024.03.012]
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不同部位注射吲哚菁绿示踪下肢淋巴回流通路及子宫旁淋巴回流通路观察
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
期数:
2024年3
页码:
262-265
栏目:
临床研究
出版日期:
2024-03-05

文章信息/Info

Title:
Observations of lower limb lymphatic reflux and para-uterine lymphatic reflux by injecting indocyanine green
作者:
赵锦丽; 刘光新; 于鹤
（周口市中心医院妇科,河南　周口　466000）
Author(s):
ZHAO Jinli; LIU Guangxin; YU He
(Department of Gynecology,Zhoukou Central Hospital,Zhoukou 466000,Henan Province,China)
关键词:
吲哚菁绿; 淋巴回流通路; 下肢淋巴水肿; 荧光腹腔镜
Keywords:
indocyanine green; lymphatic circulation pathway; lower limb lymphedema; fluorescence laparoscopy
分类号:
R737.3
DOI:
10.7683/xxyxyxb.2024.03.012
文献标志码:
A
摘要:
目的　通过趾间注射与宫颈注射吲哚菁绿示踪，观察下肢淋巴回流通路和子宫旁淋巴回流通路的不同之处。
方法　选择2019年6月至2022年11月于周口市中心医院就诊的早期子宫内膜癌或宫颈癌患者50例为研究对象。根据术中吲哚菁绿注射的部位将患者分为趾间注射组(n=20) 和宫颈注射组 (n=30)。2组患者分别在趾间及宫颈注射吲哚菁绿，在荧光腹腔镜下观察下肢淋巴回流在盆腔内的通路以及子宫旁淋巴回流通路，重点观察二者的不同之处。
结果　趾间注射组患者（20例40侧）中下肢淋巴回流在盆腔段显影18例（33侧），2例双侧未显影。显影的患者中有26侧显示下肢淋巴回流经腹股沟深淋巴结、旋髂淋巴结、髂外淋巴结、髂总淋巴结，5侧显示下肢淋巴回流至腹股沟深淋巴结、旋髂淋巴结、闭孔淋巴结、髂内淋巴结、髂总淋巴结，2侧显示下肢淋巴回流至腹股沟深淋巴结、闭孔淋巴结、髂内淋巴结、髂总淋巴结。 宫颈注射组患者（30例60侧）中盆腔内淋巴显影29例55侧，1例双侧未显影。显影的患者中2侧显示宫旁淋巴回流至闭孔淋巴结、旋髂淋巴结、髂外淋巴结、髂总淋巴结，其中旋髂淋巴结均为非前哨淋巴结；40侧显示宫旁淋巴回流沿着上宫颈旁淋巴回流通路至髂外内侧淋巴结（或闭孔淋巴结）、髂总淋巴结；13侧显示沿着下宫颈旁淋巴回流通路至髂内淋巴结或骶前淋巴结。下肢淋巴回流与子宫旁淋巴回流的共同引流途径是由闭孔、髂外、髂总淋巴向上回流。趾间注射组和宫颈注射组旋髂淋巴结显影率分别为93.94%（31/33）、3.63%（2/55）,趾间注射组旋髂淋巴结显影率显著高于宫颈注射组（P<0.05）。
结论　应用吲哚菁绿示踪剂在荧光腹腔镜下能更直观地看到下肢淋巴回流及子宫旁淋巴回流通路，二者的淋巴回流不同之处在于下肢淋巴回流经髂外淋巴结远端的旋髂淋巴结，而宫颈癌和子宫内膜癌很少转移至此。
Abstract:
Objective　To observe the differences between the lymphatic reflux in the lower extremities and near the uterus by interphalangeal and cervical injection of indocyanine green (ICG).
Methods　A total of 50 patients with early-stage endometrial cancer or cervical cancer admitted to Zhoukou Central Hospital from June 2019 to November 2022 were selected as the research subjects.According to the ICG injection site during the surgery,patients were divided into the interphalangeal injection group (n=20) and the cervical injection group (n=30).The patients in the two groups were injected with ICG at the toes or cervix uteri,respectively.The lower limb lymphatic reflux pathway in the pelvic cavity and the para-uterine lymphatic reflux pathway were observed under fluorescence laparoscopy,and the differences between the two groups were analyzed.
Results　Among the patients with the interphalangeal injection of ICG (20 patients,40 sides),the lower limb lymphatic reflux was developed on 33 sides of 18 patients but not developed on both sides of 2 patients.Among the 18 patients,26 sides showed the lower limb lymphatic reflux through deep inguinal lymph nodes,circumflex iliac lymph nodes,external iliac lymph nodes,and common iliac lymph nodes;5 sides showed the lower limb lymphatic reflux to deep inguinal lymph nodes,circumflex iliac lymph nodes,obturator lymph nodes,internal iliac lymph nodes,and common iliac lymph nodes;and 2 sides showed the lower limb lymphatic reflux to deep inguinal lymph nodes,obturator lymph nodes,internal iliac lymph nodes,and common iliac lymph nodes.Among the patients with the cervical injection of ICG (30 patients,60 sides),pelvic lymph nodes were developed on 55 sides of 29 patients but not developed bilaterally in 1 patient.In the 29 patients,2 sides showed para-uterine lymphatic reflux to obturator lymph nodes,circumflex iliac lymph nodes,external iliac lymph nodes,and common iliac lymph nodes,in which circumflex iliac lymph nodes were non-sentinel lymph nodes;40 sides showed para-uterine lymphatic reflux to medial iliac lymph nodes (or obturator lymph nodes) and common iliac lymph nodes along the superior paracervical lymphatic reflux pathway;and 13 sides showed para-uterine lymphatic reflux to the internal iliac or presacral lymph nodes along the inferior paracervical lymphatic reflux pathway.The shared pathway of lower limb lymphatic reflux and para-uterine lymphatic reflux was upward reflux from obturator,external iliac and common iliac lymph nodes.The circumflex iliac lymph node developing rates in the interphalangeal and cervical injection groups were 93.94% (31/33) and 3.63% (2/55),respectively.The interphalangeal injection group had a significantly higher circumflex iliac lymph node developing rate than the cervical injection group (P<0.05).
Conclusion　The application of ICG under fluorescence laparoscopy intuitively observed the lower limb lymphatic reflux and the para-uetine lymphatic reflux pathway.The difference between the two is that the lower limb lymphatic reflux flows through the circumflex iliac lymph nodes at the distal end of the external iliac lymph nodes,while cervical cancer and endometrial cancer rarely transfer there.

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更新日期/Last Update: 2024-03-05