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用于手和手腕染料注射的解剖学支持在股逆向映射中

James E Fanning¹, Rosie Friedman¹, Angela Chen¹

¹Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.

Annals of surgical oncology

|July 8, 2025

概括

与传统的上臂注射相比,手/手腕注射用于腹逆映射 (ARM) 识别了较少的靠近腹静脉的淋巴管道. 这表明,上臂注射在乳腺癌手术期间更有效地保护手臂淋巴管.

科学领域:

手术瘤学手术瘤学
淋巴 edem 研究研究淋巴 edem 研究
淋巴细胞成像系统的成像

背景情况:

轴心逆向映射 (ARM) 对于在轴心淋巴结解剖 (ALND) 期间保护手臂淋巴细胞至关重要,旨在减少与乳腺癌相关的淋巴 (BCRL).
没有确定ARM染料的最佳注射部位.
这项研究评估了在接受ALND并立即进行淋巴重建 (ILR) 的患者中对ARM的光素异硫酸盐 (FITC) 注射部位.

研究的目的:

为了比较手/手腕与中间上臂FITC注射在ARM期间可视化淋巴管道的有效性.
确定注射部位对可视化淋巴管道的数量,近距离和直径的影响.

主要方法:

在2017年9月至2023年5月期间,ALND后接受ILR的323名患者的回顾性审查.
收集的数据包括染料注射部位,可视化淋巴管道的数量,距离骨静脉的距离和管道直径.
统计分析包括奇平方和曼-惠特尼U测试,以比较注射组之间的结果.

主要成果:

180名患者接受了手/手腕注射,143人接受了中部上臂注射.
在手/手腕注射时可视化的淋巴管道较少 (p=0.011).
在手/手腕注射后可视化的通道更接近腹静脉 (中位数为2.3厘米与2.7厘米,p<0.001),直径没有显著差异 (p=0.066).

结论:

用于ARM的手/手腕注射可视化了较少的淋巴管道,并且它们位于靠近骨静脉的位置.
这些发现支持了解剖学的理解,主要的手臂淋巴血管沿着骨静脉运行.
在乳腺癌手术的ARM期间,中部上臂注射似乎更有效地识别关键的淋巴管道.

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